Article Text

PDF
FRI0462 Does Serum NT-Probnp Test Facilitate Diagnosis of PAH in Patients with SSC?
  1. E. Nikolaeva,
  2. E. Alexandrova,
  3. A. Novikov,
  4. I. Kurmukov,
  5. N. Yudkina,
  6. D. Novikova,
  7. A. Volkov
  1. Nasonova V.A. Research Institute of Rheumatology, Moscow, Russian Federation

Abstract

Background Pulmonary arterial hypertension (PAH) is a progressive vasculopathy that is advanced by the time symptoms develop. Screening can help; however, multiple investigations, including annual echocardiography, DLCO etc., have low specificity and may not be cost-effective.

Objectives We sought to evaluate the predictive level and accuracy of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) in a screening for SSc-PAH.

Methods We studied 65 SSc patients with various forms of PH and 25 SSc patients without PH, confirmed by right heart catheterization (RHC). SSc was diagnosed in accordance with EULAR/ACR criteria (2013). Demographics studies, physical examination, vital signs measurement, 6-minute walk test, echocardiography, pulmonary function testing, and biomarker levels (N-terminal pro-brain natriuretic peptide [NT-proBNP] and uric acid) were done within 24 hours before RHC. We got 4 groups of patients

Results

Age differences were not significantly. NT-proBNP levels didn't differ in groups PAH-SSc and PH-LHD, and were significantly higher than in other groups (* - p<0,0001). NT-proBNP correlated with NYHA functional class (r 0.57; p 0.00002), 6-MWT (r -0.58; p 0.000009), uric acid level (r 0.56; p 0.00002), right atrial pressure (r 0.43; p 0.002), mean pulmonary artery pressure (r 0.49; p 0.0004), cardiac output (r -0.53; p 0.0002), pulmonary vascular resistance (r 0.65; p 0.000001), SSc-severity index (r 0.44; p 0.003) and presence of signs of the heart failure (peripheral oedema (p 0.00002) and GFR decrease (p 0.008)).

ROC curve analyses were performed to determine the optimal cut-off point for NT-proBNP and other variables in prediction of PAH. NT-proBNP at the level of >252,5 pg/mL, predicts the presence of SSc-PAH with sensitivity of 82% and specificity of 72%; positive predictive value for SSc-PAH was 86,6%, negative predictive value – 72,4%; risk of PAH was 3.66-fold higher than for other forms PH (95%CI 1.45; 9,21) (p=0.0059). Hazard ratio for PH-LHD was 4.99 (95% CI 0.61;40,59). Unfortunatelly, this fact was not significant (p=0.13).

Conclusions Increased serum NT-proBNP can be considered as detecting factor of SSc-PAH provided left heart diseases are excluded.

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.