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
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
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