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N-terminal pro-brain natriuretic peptide in a novel screening algorithm for pulmonary arterial hypertension in systemic sclerosis: a case-control study.
Arthritis Res Ther. 2012 Jun 12; 14(3):R143.AR

Abstract

INTRODUCTION

Pulmonary arterial hypertension is a major cause of mortality in systemic sclerosis. N-terminal pro-brain natriuretic peptide (NT-proBNP) has emerged as a candidate biomarker that may enable the early detection of systemic sclerosis-related pulmonary arterial hypertension (SSc-PAH). The objective of our study was to incorporate NT-proBNP into a screening algorithm for SSc-PAH that could potentially replace transthoracic echocardiography (TTE) as a more convenient and less costly "first tier" test.

METHODS

NT-proBNP levels were measured in patients from four clinical groups: a group with right heart catheter (RHC)-diagnosed SSc-PAH before commencement of therapy for PAH; a group at high risk of SSc-PAH based on TTE; a group with interstitial lung disease; and systemic sclerosis (SSc) controls with no cardiopulmonary complications. NT-proBNP levels were compared by using ANOVA and correlated with other clinical variables by using simple and multiple linear regression. ROC curve analyses were performed to determine the optimal cut point for NT-proBNP and other clinical variables in prediction of PAH.

RESULTS

NT-proBNP was highest in the PAH group compared with other groups (P < 0.0001), and higher in the risk group compared with controls (P < 0.0001). NT-proBNP was positively correlated with systolic pulmonary artery pressure (PAP) on TTE (P < 0.0001), and mean PAP (P = 0.013), pulmonary vascular resistance (P = 0.005), and mean right atrial pressure (P = 0.006) on RHC. A composite model wherein patients screened positive if NT-proBNP was ≥ 209.8 pg/ml, and/or DLCOcorr was < 70.3% with FVC/DLCOcorr ≥ 1.82, had a sensitivity of 100% and specificity of 77.8% for SSc-PAH.

CONCLUSION

We have proposed a screening algorithm for SSc-PAH, incorporating NT-proBNP level and PFTs. This model has high sensitivity and specificity for SSc-PAH and, if positive, should lead to TTE and confirmatory testing for PAH. This screening algorithm must be validated prospectively.

Authors+Show Affiliations

Department of Rheumatology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22691291

Citation

Thakkar, Vivek, et al. "N-terminal Pro-brain Natriuretic Peptide in a Novel Screening Algorithm for Pulmonary Arterial Hypertension in Systemic Sclerosis: a Case-control Study." Arthritis Research & Therapy, vol. 14, no. 3, 2012, pp. R143.
Thakkar V, Stevens WM, Prior D, et al. N-terminal pro-brain natriuretic peptide in a novel screening algorithm for pulmonary arterial hypertension in systemic sclerosis: a case-control study. Arthritis Res Ther. 2012;14(3):R143.
Thakkar, V., Stevens, W. M., Prior, D., Moore, O. A., Byron, J., Liew, D., Patterson, K., Hissaria, P., Roddy, J., Zochling, J., Sahhar, J., Nash, P., Tymms, K., Celermajer, D., Gabbay, E., Youssef, P., Proudman, S. M., & Nikpour, M. (2012). N-terminal pro-brain natriuretic peptide in a novel screening algorithm for pulmonary arterial hypertension in systemic sclerosis: a case-control study. Arthritis Research & Therapy, 14(3), R143. https://doi.org/10.1186/ar3876
Thakkar V, et al. N-terminal Pro-brain Natriuretic Peptide in a Novel Screening Algorithm for Pulmonary Arterial Hypertension in Systemic Sclerosis: a Case-control Study. Arthritis Res Ther. 2012 Jun 12;14(3):R143. PubMed PMID: 22691291.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - N-terminal pro-brain natriuretic peptide in a novel screening algorithm for pulmonary arterial hypertension in systemic sclerosis: a case-control study. AU - Thakkar,Vivek, AU - Stevens,Wendy M, AU - Prior,David, AU - Moore,Owen A, AU - Byron,Jillian, AU - Liew,Danny, AU - Patterson,Karen, AU - Hissaria,Pravin, AU - Roddy,Janet, AU - Zochling,Jane, AU - Sahhar,Joanne, AU - Nash,Peter, AU - Tymms,Kathleen, AU - Celermajer,David, AU - Gabbay,Eli, AU - Youssef,Peter, AU - Proudman,Susanna M, AU - Nikpour,Mandana, Y1 - 2012/06/12/ PY - 2012/03/23/received PY - 2012/06/12/accepted PY - 2012/6/14/entrez PY - 2012/6/14/pubmed PY - 2013/5/23/medline SP - R143 EP - R143 JF - Arthritis research & therapy JO - Arthritis Res. Ther. VL - 14 IS - 3 N2 - INTRODUCTION: Pulmonary arterial hypertension is a major cause of mortality in systemic sclerosis. N-terminal pro-brain natriuretic peptide (NT-proBNP) has emerged as a candidate biomarker that may enable the early detection of systemic sclerosis-related pulmonary arterial hypertension (SSc-PAH). The objective of our study was to incorporate NT-proBNP into a screening algorithm for SSc-PAH that could potentially replace transthoracic echocardiography (TTE) as a more convenient and less costly "first tier" test. METHODS: NT-proBNP levels were measured in patients from four clinical groups: a group with right heart catheter (RHC)-diagnosed SSc-PAH before commencement of therapy for PAH; a group at high risk of SSc-PAH based on TTE; a group with interstitial lung disease; and systemic sclerosis (SSc) controls with no cardiopulmonary complications. NT-proBNP levels were compared by using ANOVA and correlated with other clinical variables by using simple and multiple linear regression. ROC curve analyses were performed to determine the optimal cut point for NT-proBNP and other clinical variables in prediction of PAH. RESULTS: NT-proBNP was highest in the PAH group compared with other groups (P < 0.0001), and higher in the risk group compared with controls (P < 0.0001). NT-proBNP was positively correlated with systolic pulmonary artery pressure (PAP) on TTE (P < 0.0001), and mean PAP (P = 0.013), pulmonary vascular resistance (P = 0.005), and mean right atrial pressure (P = 0.006) on RHC. A composite model wherein patients screened positive if NT-proBNP was ≥ 209.8 pg/ml, and/or DLCOcorr was < 70.3% with FVC/DLCOcorr ≥ 1.82, had a sensitivity of 100% and specificity of 77.8% for SSc-PAH. CONCLUSION: We have proposed a screening algorithm for SSc-PAH, incorporating NT-proBNP level and PFTs. This model has high sensitivity and specificity for SSc-PAH and, if positive, should lead to TTE and confirmatory testing for PAH. This screening algorithm must be validated prospectively. SN - 1478-6362 UR - https://www.unboundmedicine.com/medline/citation/22691291/N_terminal_pro_brain_natriuretic_peptide_in_a_novel_screening_algorithm_for_pulmonary_arterial_hypertension_in_systemic_sclerosis:_a_case_control_study_ L2 - https://arthritis-research.biomedcentral.com/articles/10.1186/ar3876 DB - PRIME DP - Unbound Medicine ER -