L. Chung1, R. Fairchild2, D. Furst3, S. Li4, F. Alkassab5, M. Bolster6, M. Csuka7, C. Derk8, R. Domsic9, A. Fischer10, T. Frech11, M. Gomberg-Maitland12, J. Gordon13, M. Hinchcliff14, V. Hsu15, L. Hummers16, D. Khanna17, T. Medsger18, J. Molitor19, I. Preston20, E. Schiopu21, L. Shapiro22, F. Hant23, R. Silver24, R. Simms25, J. Varga26, V. Steen27, R. Zamanian28
2017 Vol.35, N°4 ,Suppl.106 - PI 0106, PF 0113
To assess the utility of B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) in detecting and monitoring pulmonary hypertension (PH) in systemic sclerosis (SSc).
PHAROS is a multicenter prospective cohort of SSc patients at high risk for developing pulmonary arterial hypertension (SSc-AR-PAH) or with a definitive diagnosis of SSc-PH. We evaluated 1) the sensitivity and specificity of BNP≥64 and NT-proBNP≥210 pg/mL for the detection of SSc-PAH and/ or SSc-PH in the SSc-AR-PAH population; 2) baseline and longitudinal BNP and NT-proBNP levels as predictors of progression to SSc-PAH and/or SSc-PH; 3) baseline BNP≥180, NT-proBNP≥553 pg/mL, and longitudinal changes in BNP and NT-proBNP as predictors of mortality in SSc-PH diagnosed patients.
172 SSc-PH and 157 SSc-AR- PAH patients had natriuretic peptide levels available. Median BNP and NT-proBNP were significantly higher in the SSc-PH versus SSc-AR-PAH group. The sensitivity and specificity for SSc-PAH detection using baseline BNP≥64 pg/mL was 71% and 59%; and for NT-proBNP≥210 pg/mL, 73% and 78%. NT-proBNP showed stronger correlations with haemodynamic indicators of right ventricular dysfunction than BNP. Baseline creatinine, RVSP > 40 mmHg, and FVC%:DLco% ratio ≥1.8 were associated with progression from SSc-AR-PAH to SSc-PH but no association with individual or combined baseline BNP and NT-proBNP levels was observed. Baseline and follow-up BNP or NT-proBNP levels were not predictive of death, however, a composite BNP/NT-proBNP group predicted mortality (HR 3.81 (2.08-6.99), p<.0001).
NT-proBNP may be more useful than BNP in the detection and monitoring of PAH in SSc patients, but additional studies are necessary.
PMID: 27908301 [PubMed]
Received: 01/03/2016 - Accepted : 28/09/2016 - In Press: 10/11/2016 - Published: 27/10/2017