Significance of plasma N-terminal pro-brain natriuretic peptide in patients with systemic sclerosis-related pulmonary arterial hypertension

• Published in: Respiratory medicine Vol. 97; no. 11; pp. 1230 - 1236
• Main Authors: Mukerjee, D, Yap, L.B, Holmes, A.M, Nair, D, Ayrton, P, Black, C.M, Coghlan, J.G
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.11.2003; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Amino acids; Atrial Natriuretic Factor - blood; Biological and medical sciences; Cardiac catheterisation; Exercise - physiology; Female; Hemodynamics - physiology; Humans; Hypertension; Hypertension, Pulmonary - blood; Hypertension, Pulmonary - complications; Hypertension, Pulmonary - diagnosis; Hypertension, Pulmonary - physiopathology; Male; Medical sciences; Middle Aged; Multivariate analysis; N-Terminal proBNP; Peptides; Pilot Projects; Plasma; Pneumology; Protein Precursors - blood; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; Right ventricular dysfunction; Risk Factors; ROC Curve; Rodents; Scleroderma, Systemic - blood; Scleroderma, Systemic - complications; Scleroderma, Systemic - physiopathology; Studies; Systemic sclerosis-related pulmonary hypertension (SScPAH); RVEDP, right ventricular end diastolic pressure; Cardiac catheterisation; NT-proBNP, N-terminal pro-brain natriuretic peptide; PVR, pulmonary vascular resistance; ROC, receiver operating characteristic; RV, right ventricle; mean PAP, mean pulmonary artery pressure; PCWP, pulmonary capillary wedge pressure; N-Terminal proBNP; Right ventricular dysfunction; Systemic sclerosis-related pulmonary hypertension (SScPAH); se, standard error; SScPAH, systemic sclerosis-related pulmonary arterial hypertension; Human; Heart failure; Brain natriuretic peptide; Pathophysiology; Respiratory disease; Right ventricle performance; Cardiovascular disease; Exploration; Pulmonary hypertension; Lung function; Heart disease; Complication; Hemodynamics; Systemic sclerosis-related pulmonary hypertension (SSCPAH)
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/S0954-6111(03)00254-3

Objectives: A single centre pilot study to investigate the role of the plasma N-terminal pro-brain natriuretic peptide (N-T proBNP) assay to risk stratify patients with suspected pulmonary arterial hypertension (PAH) from a background SSc population. Methods: Out of 49 SSc patients, 23 had and 26 did not have PAH. Right ventricular haemodynamic variables, six-minute walk test and plasma N-T proBNP levels were recorded from patients catheterised for suspected PAH (23 with PAH and 11/26 without PAH). Results: Mean value of N-T proBNP for SSc patients with PAH was 3365 (standard error 1095) pg/ml compared to 347 (174) pg/ml for patients without PAH. There was a statistically significant correlation ( P<0.05) between N-T proBNP values and (i) mean pulmonary artery pressure ( r=0.53), (ii) right ventricular end diastolic pressure ( r=0.59) and (iii) pulmonary vascular resistance ( r=0.49). Receiver operator characteristic curve analysis showed that a cut-off value of 395.34 pg/ml had a sensitivity of 0.69 and specificity of 1.0. Conclusions: N-T proBNP estimation in systemic sclerosis-related pulmonary hypertension is a potentially useful diagnostic tool with a high specificity and negative predictive value. This test has the potential to have an important role in risk stratification and monitoring of therapy in the future.