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Utility of B-type natriuretic peptides in the assessment of patients with systemic sclerosis-associated pulmonary hypertension in the PHAROS registry.
Clin Exp Rheumatol. 2017 Sep-Oct; 35 Suppl 106(4):106-113.CE

Abstract

OBJECTIVES

To assess the utility of B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) in detecting and monitoring pulmonary hypertension (PH) in systemic sclerosis (SSc).

METHODS

PHAROS is a multicenter prospective cohort of SSc patients at high risk for developing pulmonary arterial hypertension (SSc-AR-PAH) or with a definitive diagnosis of SSc-PH. We evaluated 1) the sensitivity and specificity of BNP≥64 and NT-proBNP≥210 pg/mL for the detection of SSc-PAH and/ or SSc-PH in the SSc-AR-PAH population; 2) baseline and longitudinal BNP and NT-proBNP levels as predictors of progression to SSc-PAH and/or SSc-PH; 3) baseline BNP≥180, NT-proBNP≥553 pg/mL, and longitudinal changes in BNP and NT-proBNP as predictors of mortality in SSc-PH diagnosed patients.

RESULTS

172 SSc-PH and 157 SSc-AR- PAH patients had natriuretic peptide levels available. Median BNP and NT-proBNP were significantly higher in the SSc-PH versus SSc-AR-PAH group. The sensitivity and specificity for SSc-PAH detection using baseline BNP≥64 pg/mL was 71% and 59%; and for NT-proBNP≥210 pg/mL, 73% and 78%. NT-proBNP showed stronger correlations with haemodynamic indicators of right ventricular dysfunction than BNP. Baseline creatinine, RVSP > 40 mmHg, and FVC%:DLco% ratio ≥1.8 were associated with progression from SSc-AR-PAH to SSc-PH but no association with individual or combined baseline BNP and NT-proBNP levels was observed. Baseline and follow-up BNP or NT-proBNP levels were not predictive of death, however, a composite BNP/NT-proBNP group predicted mortality (HR 3.81 (2.08-6.99), p<.0001).

CONCLUSIONS

NT-proBNP may be more useful than BNP in the detection and monitoring of PAH in SSc patients, but additional studies are necessary.

Authors+Show Affiliations

Stanford University, Stanford, CA and VA Palo Alto Health Care System, Palo Alto, CA, USA. shauwei@stanford.edu.Stanford University, Stanford, CA, USA.University of California Los Angeles, CA, USA.Stanford University, Stanford, CA, USA.University of Massachusetts Medical School, Worcester, MA/University of North Carolina-Chapel Hill, Charlotte, NC, USA.Massachusetts General Hospital, Boston, MA, USA.Medical College of Wisconsin, Milwaukee, WI, USA.University of Pennsylvania, Philadelphia, PA, USA.University of Pittsburgh, PA, USA.University of Colorado School of Medicine, Aurora, CO, USA.University of Utah, Salt Lake City, UT, USA.University of Chicago, IL, USA.Hospital for Special Surgery, New York, NY, USA.Northwestern University, Chicago, IL, USA.Rutgers-RWJ Medical School, New Brunswick, NJ, USA.Johns Hopkins University, Baltimore, MD, USA.University of Michigan, Ann Arbor, MI, USA.University of Pittsburgh, PA, USA.University of Minnesota, Minneapolis, MN, USA.Tufts University School of Medicine, Boston, MA, USA.University of Michigan, Ann Arbor, MI, USA.Center for Rheumatology, Albany, NY, USA.Medical University of South Carolina, Charleston, SC, USA.Medical University of South Carolina, Charleston, SC, USA.Boston University, Boston, MA, USA.Northwestern University, Chicago, IL, USA.Georgetown University, Washington, DC, USA.Stanford University, Stanford, CA, and Vera Moulton Wall Center for Pulmonary Vascular Disease, USA.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

27908301

Citation

Chung, Lorinda, et al. "Utility of B-type Natriuretic Peptides in the Assessment of Patients With Systemic Sclerosis-associated Pulmonary Hypertension in the PHAROS Registry." Clinical and Experimental Rheumatology, vol. 35 Suppl 106, no. 4, 2017, pp. 106-113.
Chung L, Fairchild RM, Furst DE, et al. Utility of B-type natriuretic peptides in the assessment of patients with systemic sclerosis-associated pulmonary hypertension in the PHAROS registry. Clin Exp Rheumatol. 2017;35 Suppl 106(4):106-113.
Chung, L., Fairchild, R. M., Furst, D. E., Li, S., Alkassab, F., Bolster, M. B., Csuka, M. E., Derk, C. T., Domsic, R. T., Fischer, A., Frech, T. M., Gomberg-Maitland, M., Gordon, J. K., Hinchcliff, M., Hsu, V., Hummers, L. K., Khanna, D., Medsger, T. A. J., Molitor, J. A., ... Zamanian, R. T. (2017). Utility of B-type natriuretic peptides in the assessment of patients with systemic sclerosis-associated pulmonary hypertension in the PHAROS registry. Clinical and Experimental Rheumatology, 35 Suppl 106(4), 106-113.
Chung L, et al. Utility of B-type Natriuretic Peptides in the Assessment of Patients With Systemic Sclerosis-associated Pulmonary Hypertension in the PHAROS Registry. Clin Exp Rheumatol. 2017 Sep-Oct;35 Suppl 106(4):106-113. PubMed PMID: 27908301.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Utility of B-type natriuretic peptides in the assessment of patients with systemic sclerosis-associated pulmonary hypertension in the PHAROS registry. AU - Chung,Lorinda, AU - Fairchild,Robert M, AU - Furst,Daniel E, AU - Li,Shufeng, AU - Alkassab,Firas, AU - Bolster,Marcy B, AU - Csuka,Mary Ellen, AU - Derk,Chris T, AU - Domsic,Robyn T, AU - Fischer,Aryeh, AU - Frech,Tracy M, AU - Gomberg-Maitland,Mardi, AU - Gordon,Jessica K, AU - Hinchcliff,Monique, AU - Hsu,Vivien, AU - Hummers,Laura K, AU - Khanna,Dinesh, AU - Medsger,Thomas A Jr, AU - Molitor,Jerry A, AU - Preston,Ivana R, AU - Schiopu,Elena, AU - Shapiro,Lee, AU - Hant,Faye, AU - Silver,Richard, AU - Simms,Robert, AU - Varga,John, AU - Steen,Virginia D, AU - Zamanian,Roham T, Y1 - 2016/11/10/ PY - 2016/03/01/received PY - 2016/09/28/accepted PY - 2016/12/3/pubmed PY - 2017/12/22/medline PY - 2016/12/3/entrez SP - 106 EP - 113 JF - Clinical and experimental rheumatology JO - Clin. Exp. Rheumatol. VL - 35 Suppl 106 IS - 4 N2 - OBJECTIVES: To assess the utility of B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) in detecting and monitoring pulmonary hypertension (PH) in systemic sclerosis (SSc). METHODS: PHAROS is a multicenter prospective cohort of SSc patients at high risk for developing pulmonary arterial hypertension (SSc-AR-PAH) or with a definitive diagnosis of SSc-PH. We evaluated 1) the sensitivity and specificity of BNP≥64 and NT-proBNP≥210 pg/mL for the detection of SSc-PAH and/ or SSc-PH in the SSc-AR-PAH population; 2) baseline and longitudinal BNP and NT-proBNP levels as predictors of progression to SSc-PAH and/or SSc-PH; 3) baseline BNP≥180, NT-proBNP≥553 pg/mL, and longitudinal changes in BNP and NT-proBNP as predictors of mortality in SSc-PH diagnosed patients. RESULTS: 172 SSc-PH and 157 SSc-AR- PAH patients had natriuretic peptide levels available. Median BNP and NT-proBNP were significantly higher in the SSc-PH versus SSc-AR-PAH group. The sensitivity and specificity for SSc-PAH detection using baseline BNP≥64 pg/mL was 71% and 59%; and for NT-proBNP≥210 pg/mL, 73% and 78%. NT-proBNP showed stronger correlations with haemodynamic indicators of right ventricular dysfunction than BNP. Baseline creatinine, RVSP > 40 mmHg, and FVC%:DLco% ratio ≥1.8 were associated with progression from SSc-AR-PAH to SSc-PH but no association with individual or combined baseline BNP and NT-proBNP levels was observed. Baseline and follow-up BNP or NT-proBNP levels were not predictive of death, however, a composite BNP/NT-proBNP group predicted mortality (HR 3.81 (2.08-6.99), p<.0001). CONCLUSIONS: NT-proBNP may be more useful than BNP in the detection and monitoring of PAH in SSc patients, but additional studies are necessary. SN - 0392-856X UR - https://www.unboundmedicine.com/medline/citation/27908301/Utility_of_B_type_natriuretic_peptides_in_the_assessment_of_patients_with_systemic_sclerosis_associated_pulmonary_hypertension_in_the_PHAROS_registry_ L2 - http://www.clinexprheumatol.org/pubmed/find-pii.asp?pii=27908301 DB - PRIME DP - Unbound Medicine ER -