Article Text

PDF
THU0258 N-terminal pro-brain natriuretic peptide in a novel screening algorithm for pulmonary arterial hypertension in systemic sclerosis
  1. V. Thakkar1,
  2. W. Stevens1,
  3. D. Prior1,
  4. O. Moore1,
  5. J. Byron1,
  6. K. Patterson2,
  7. P. Hissaria2,
  8. J. Roddy3,
  9. J. Zochling4,
  10. J. Sahhar5,
  11. P. Nash6,
  12. K. Tymms7,
  13. D. Celermajer8,
  14. E. Gabbay3,
  15. P. Youssef8,
  16. S. Proudman2,
  17. M. Nikpour1,9
  18. and Australian Scleroderma Interest Group
  1. 1St Vincent’s Hospital, Melbourne
  2. 2Royal Adelaide Hospital, Adelaide
  3. 3Royal Perth Hospital, Perth
  4. 4The Menzies Institute, Hobart
  5. 5Monash Medical Centre, Melbourne
  6. 6Sunshine Coast Rheumatology, Maroochydore
  7. 7Canberra Rheumatology, Canberra
  8. 8Royal Prince Alfred Hospital, Sydney
  9. 9University of Melbourne, Melbourne, Australia

Abstract

Background Pulmonary Arterial Hypertension (PAH) is a major cause of mortality in SSc. 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).

Objectives To incorporate N-terminal pro-brain natriuretic peptide (NT-proBNP) into a screening algorithm for systemic sclerosis-related pulmonary arterial hypertension (SSc-PAH) that could potentially replace transthoracic echocardiography (TTE) as a less costly and more convenient “first tier” test.

Methods NT-proBNP levels were measured in patients from 4 clinical groups: a group with right heart catheter (RHC) diagnosed SSc-PAH prior to 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 using ANOVA and correlated with other clinical variables 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 to other groups (p<0.0001), and higher in the risk group compared to controls (p<0.0001). NT-proBNP was positively correlated with systolic pulmonary artery pressure (PAP) on TTE (p<0.0001), and mean PAP (p=0.008), pulmonary vascular resistance (p=0.001) and mean right atrial pressure (p=0.006) on RHC. A composite model wherein patients screened positive if NT-proBNP ≥209.8pg/ml, and/or DLCOcorr <70.3% with FVC/DLCOcorr ≥1.83, had a sensitivity of 100% and specificity of 77.8% for SSc-PAH.

Conclusions 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 needs to be validated prospectively.

Disclosure of Interest None Declared

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.