Article Text

other Versions

PDF
N-terminal brain natriuretic peptide in systemic sclerosis: a new cornerstone of cardiovascular assessment?
  1. Yannick Allanore (yannick.allanore{at}cch.aphp.fr)
  1. Rheumatology A, Paris Descartes University, Cochin Hospital, France
    1. Karim Wahbi
    1. Cardiology, Paris Descartes University, Cochin Hospital, France
      1. Didier Borderie
      1. Biochemistry A, Paris Descartes University, Cochin Hospital, France
        1. Simon Weber
        1. Cardiology, Paris Descartes University, Cochin Hospital, France
          1. André Kahan
          1. Rheumatology A, Paris Descartes University, Cochin Hospital, France
            1. Christophe Meune
            1. Cardiology, Paris Descartes University, Cochin Hospital, France

              Abstract

              Background and study objective: Cardiac involvement, a common and often fatal complication of systemic sclerosis (SSc), is currently detected by standard echocardiography enhanced by tissue-Doppler echocardiography (TDE). We examined the performance of the biomarker of cardiovascular disease, N-terminal brain natriuretic peptide (NT-proBNP), in the detection of cardiac involvement by SSc.

              Methods: We prospectively studied 69 consecutive patients suffering from SSc (mean age = 56±13 years, 56 women) with standard echocardiography and TDE measurements of longitudinal mitral and tricuspid annular velocities. Plasma NT-proBNP was measured in all patients.

              Results: Overall, 18 patients had manifestations of cardiac involvement, of whom 7 had depressed left ventricular and 8 depressed right ventricular myocardial contractility, and 8 had elevated systolic pulmonary arterial pressure. Patients with reduced contractility had increased mean NT-proBNP (704±878 pg/ml versus 118±112 pg/ml in patients with normal myocardial contractility, p<0.0001). Similarly, NT-proBNP was higher in patients with (607±758 pg/ml) than in patients without (96±78 pg/ml) manifestations of overall cardiac involvement (p<0.0001). Receiver-operating-characteristics analysis shows that NT-proBNP reliably detected depressed myocardial contractility and overall cardiac involvement (area under the curve 0.905[0.814-0.996] and 0.935 [0.871-0.996] respectively). Considering SSc patients with normal echocardiography and TDE as controls, and using a 125pg/ml cut-off concentration, sensitivity and specificity were 92% and 71% in the detection of depressed myocardial contractility, and 94% and 78% for overall cardiac involvement.

              Conclusions: NT-proBNP reliably detected the presence of cardiac involvement and appears as a very useful marker to risk stratify patients presenting with SSc.

              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.