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AB0790 Impairment of the left ventricle (LV) and right ventricle (RV) of the heart in patients with systemic sclerosis and their association with level of interleukin 6 (IL-6) and n-terminal prohormone of brain natriuretic peptide (NT-PROBNP) – own experiences
  1. B. Trzcinska-Butkiewicz1,
  2. M. Peregud-Pogorzelska2,
  3. M. Wόdecki1,
  4. M. Brzosko1
  1. 1Department of Rheumatology and Internal Medicine
  2. 2Department of Cardiology, Pomeranian Medical Unviersity, Szczecin, Poland

Abstract

Background Involvement of heart in SS is estimated at 10-15%. Biomarker for heart failure and pulmonary artery hypertension (PAH) in the SS is NT-proBNP. Interleukin 6 is a proinflammatory cytokine, that participates in the pathogenesis of SS and heart damage.

Objectives The aim of this study was to assess the relationship between RV and LV failure and their relation with the concentration of NT-proBNP and IL-6.

Methods In study was enrolled 75 patients with SS aged 21 to 75 years. Control group consisted of 47 healthy subjects aged 21-77 years. Both groups were matched to the sex and age. Patients underwent echocardiography one and two dimension and Doppler analysis evaluating the selected parameters of the function of the left (LA, LVEDD, LVESD, IVSD, LVPW, IVRT, Mit E/A, LVEF, FS) and the right heart (RA, RVEDD, RVESD, RVH, Tr E/A, TAPS, ACT in the pulmonary artery, TRPG, MPA). In both groups was determined the level of NT-proBNP and IL-6 in serum. Ranges of reference values for NT-proBNP and IL-6 was determined on the basis of their concentrations in the control group. NT-proBNP concentrations were divided into three concentration ranges: normal, medium and high. Study was accepted by local ethical commission (BN-001/15/06 and BN-001/143/07).

Results In patients with SS were found: 13.51% at the higher concentrations of NT-proBNP in the range of medium values, with 37.84% in the range of high value and in 38.33% of IL-6. The analysis backward step showed higher risk of elevated NT-proBNP concentrations in the range of high values (OR 31.11, 95% CI 7,89-1302,97, p=0.000) and IL-6 (OR 5.99, 95%CI 1,25-28,73 p=0.025) compared with the control. Echocardiographic study of the left heart in patients with SS was found increased dimension of: LA in 36%, LVEDD in 6.67%, LVESD in 24%, IVSD in 24%, LVPW in 34.67%, in 66.67% prolonged IVRT, in 40.28% reduced Mit E/A ratio, in 12% reduced LVEF and in 9.59% decreased FS. Higher risk of elevated NT-proBNP concentrations in the range of high value have been demonstrated in patients with enlarged LVEDD (OR 7.83, 95% CI 1,91-380,12, p=0.008) and LVESD (OR 4.47, 95% CI 1,91-380,12, p=0.027), and IL-6 in the reduced FS (OR 5.55, 95% CI 1,35-299,00, p=0.024). Assessing right heart were found increased size of:RA in 5.63%, RVEDD in 49.32%, RVESD in 27.78%, MPA in 6.94%, RVH in 15.07%, increased TRPG in 24.24%, in 9.72% reduced the ACT, in 16.67% reduced Tr E/a ratio and in 9.72% decreased TAPS. Higher risk of elevated NT-proBNP has been demonstrated in the medium values in patients with RVH (OR 7.91, 95% CI 1,33-47,22) and reduced Tr E/A ratio (OR 6.99, 95% CI 1,18-41,34), and IL-6 in the RVH (OR 5.55, 95% CI 1,35-299,00, p=0.024). Patients with SS demonstrated a higher risk of elevated NT-proBNP concentrations in the range of medium values and elevated levels of IL-6 (OR 21.01, 95% CI 2,02-218,56, p=0.011).

Conclusions Echocardiography is very useful in assessment of LV and RV failure in patients with SS. In SS NT-proBNP and IL-6 may be early biomarkers of myocardial dysfunction, The association of NT-proBNP concentrations and IL-6 suggests an inflammatory background of myocardial damage in patients with SS.

Disclosure of Interest None Declared

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