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The inclusion of N-terminal pro-brain natriuretic peptide in a sensitive screening strategy for systemic sclerosis-related pulmonary arterial hypertension: a cohort study.
Arthritis Res Ther. 2013; 15(6):R193.AR

Abstract

INTRODUCTION

Pulmonary arterial hypertension (PAH) is a major cause of mortality in systemic sclerosis (SSc). Screening guidelines for PAH recommend multiple investigations, including annual echocardiography, which together have low specificity and may not be cost-effective. We sought to evaluate the predictive accuracy of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) in combination with pulmonary function tests (PFT) (‘proposed’ algorithm) in a screening algorithm for SSc-PAH.

METHODS

We evaluated our proposed algorithm (PFT with NT-proBNP) on 49 consecutive SSc patients with suspected pulmonary hypertension undergoing right heart catherisation (RHC). The predictive accuracy of the proposed algorithm was compared with existing screening recommendations, and is presented as sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).

RESULTS

Overall, 27 patients were found to have pulmonary hypertension (PH) at RHC, while 22 had no PH. The sensitivity, specificity, PPV and NPV of the proposed algorithm for PAH was 94.1%, 54.5%, 61.5% and 92.3%, respectively; current European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines achieved a sensitivity, specificity, PPV and NPV of 94.1%, 31.8%, 51.6% and 87.5%, respectively. In an alternate case scenario analysis, estimating a PAH prevalence of 10%, the proposed algorithm achieved a sensitivity, specificity, PPV and NPV for PAH of 94.1%, 54.5%, 18.7% and 98.8%, respectively.

CONCLUSIONS

The combination of NT-proBNP with PFT is a sensitive, yet simple and non-invasive, screening strategy for SSc-PAH. Patients with a positive screening result can be referred for echocardiography, and further confirmatory testing for PAH. In this way, it may be possible to shift the burden of routine screening away from echocardiography. The findings of this study should be confirmed in larger studies.

Authors

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Pub Type(s)

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

Language

eng

PubMed ID

24246100

Citation

Thakkar, Vivek, et al. "The Inclusion of N-terminal Pro-brain Natriuretic Peptide in a Sensitive Screening Strategy for Systemic Sclerosis-related Pulmonary Arterial Hypertension: a Cohort Study." Arthritis Research & Therapy, vol. 15, no. 6, 2013, pp. R193.
Thakkar V, Stevens W, Prior D, et al. The inclusion of N-terminal pro-brain natriuretic peptide in a sensitive screening strategy for systemic sclerosis-related pulmonary arterial hypertension: a cohort study. Arthritis Res Ther. 2013;15(6):R193.
Thakkar, V., Stevens, W., Prior, D., Youssef, P., Liew, D., Gabbay, E., Roddy, J., Walker, J. G., Zochling, J., Sahhar, J., Nash, P., Lester, S., Rischmueller, M., Proudman, S. M., & Nikpour, M. (2013). The inclusion of N-terminal pro-brain natriuretic peptide in a sensitive screening strategy for systemic sclerosis-related pulmonary arterial hypertension: a cohort study. Arthritis Research & Therapy, 15(6), R193.
Thakkar V, et al. The Inclusion of N-terminal Pro-brain Natriuretic Peptide in a Sensitive Screening Strategy for Systemic Sclerosis-related Pulmonary Arterial Hypertension: a Cohort Study. Arthritis Res Ther. 2013;15(6):R193. PubMed PMID: 24246100.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The inclusion of N-terminal pro-brain natriuretic peptide in a sensitive screening strategy for systemic sclerosis-related pulmonary arterial hypertension: a cohort study. AU - Thakkar,Vivek, AU - Stevens,Wendy, AU - Prior,David, AU - Youssef,Peter, AU - Liew,Danny, AU - Gabbay,Eli, AU - Roddy,Janet, AU - Walker,Jennifer G, AU - Zochling,Jane, AU - Sahhar,Joanne, AU - Nash,Peter, AU - Lester,Susan, AU - Rischmueller,Maureen, AU - Proudman,Susanna M, AU - Nikpour,Mandana, PY - 2013/04/15/received PY - 2013/11/07/accepted PY - 2013/11/20/entrez PY - 2013/11/20/pubmed PY - 2014/11/5/medline SP - R193 EP - R193 JF - Arthritis research & therapy JO - Arthritis Res Ther VL - 15 IS - 6 N2 - INTRODUCTION: Pulmonary arterial hypertension (PAH) is a major cause of mortality in systemic sclerosis (SSc). Screening guidelines for PAH recommend multiple investigations, including annual echocardiography, which together have low specificity and may not be cost-effective. We sought to evaluate the predictive accuracy of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) in combination with pulmonary function tests (PFT) (‘proposed’ algorithm) in a screening algorithm for SSc-PAH. METHODS: We evaluated our proposed algorithm (PFT with NT-proBNP) on 49 consecutive SSc patients with suspected pulmonary hypertension undergoing right heart catherisation (RHC). The predictive accuracy of the proposed algorithm was compared with existing screening recommendations, and is presented as sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS: Overall, 27 patients were found to have pulmonary hypertension (PH) at RHC, while 22 had no PH. The sensitivity, specificity, PPV and NPV of the proposed algorithm for PAH was 94.1%, 54.5%, 61.5% and 92.3%, respectively; current European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines achieved a sensitivity, specificity, PPV and NPV of 94.1%, 31.8%, 51.6% and 87.5%, respectively. In an alternate case scenario analysis, estimating a PAH prevalence of 10%, the proposed algorithm achieved a sensitivity, specificity, PPV and NPV for PAH of 94.1%, 54.5%, 18.7% and 98.8%, respectively. CONCLUSIONS: The combination of NT-proBNP with PFT is a sensitive, yet simple and non-invasive, screening strategy for SSc-PAH. Patients with a positive screening result can be referred for echocardiography, and further confirmatory testing for PAH. In this way, it may be possible to shift the burden of routine screening away from echocardiography. The findings of this study should be confirmed in larger studies. SN - 1478-6362 UR - https://www.unboundmedicine.com/medline/citation/24246100/The_inclusion_of_N_terminal_pro_brain_natriuretic_peptide_in_a_sensitive_screening_strategy_for_systemic_sclerosis_related_pulmonary_arterial_hypertension:_a_cohort_study_ L2 - https://arthritis-research.biomedcentral.com/articles/10.1186/ar4383 DB - PRIME DP - Unbound Medicine ER -