Role of N-terminal Brain Natriuretic Peptide in Scleroderma-associated Pulmonary Arterial Hypertension PDF Print E-mail
Wednesday, 03 March 2010 10:41
Mark H. Williams, Clive E. Handler, Raza Akram, Colette J. Smith, Clare Das, Joanna Smee, Devaki Nair, Christopher P. Denton, Carol M. Black and John G. Coghlan
First published online: April 27, 2006
Source: http://eurheartj.oxfordjournals.org/content/27/12/1485.full

Aims:
The aims of this study were to evaluate the diagnostic value and to explore the prognostic value of N-terminal brain natriuretic peptide (N-TproBNP) in patients with systemic sclerosis (SSc) both with and without pulmonary arterial hypertension (PAH).

Methods and Results:
N-TproBNP, six-minute walk distance (SMWD), haemodynamics (at right heart catheterization) or tricuspid gradient (by echocardiography), and survival were assessed in 109 patients with SSc. The study population included 68 individuals with PAH [mean pulmonary artery pressure (PAP) >25 mmHg and pulmonary capillary wedge pressure <15 mmHg] and 41 individuals without PAH. In patients with PAH, the prognostic value of baseline and change in WHO functional class, N-TproBNP levels, and SMWD were compared using Kaplan–Meier survival curves and Cox proportional hazard analysis. The mean duration of follow-up was 10 months (range 1–18 months). One year survival in patients with normal PAP was 100% when compared with 83.5% in those with SSc-PAH (P<0.05). The patients without PAH had a mean N-TproBNP level of 139 pg/mL (SD 151); those with SSc-PAH had a significantly higher mean N-TproBNP level of 1474 pg/mL (SD 2642) (P=0.0002). Among patients with PAH for every order of magnitude increase in N-TproBNP level there was a four-fold increased risk of death (P=0.002 for baseline level and P=0.006 for follow-up level). Baseline N-TproBNP levels were correlated positively with mean PAP (r=0.62; P<0.0001), pulmonary vascular resistance (PVR) (r=0.81; P<0.0001), and inversely with SMWD (r=−0.46; P<0.0001). Among patients with SSc-PAH, 13 patients (19%) were in WHO functional classes II and had mean N-TproBNP levels of 325 pg/mL (SD 388). Fifty-three patients (78%) were in WHO classes III and IV and had significantly higher mean N-TproBNP levels of 1677 pg/mL (SD 2835) (P=0.02). At an N-TproBNP level of 395 pg/mL, the sensitivity and specificity for predicting the presence of SSc-PAH were 56 and 95% respectively.

Conclusion:
Raised N-TproBNP levels are directly related to the severity of PAH. In screening programs, SSc patients with an N-TproBNP in excess of 395 pg/mL have a very high probability of having pulmonary hypertension. Baseline and serial changes in N-TproBNP levels are highly predictive of survival. A 10-fold increase in N-TproBNP level on therapy is associated with a greater than three-fold increase in mortality, and may indicate therapeutic failure.

For a copy of the full article, with diagrams and analysis, please login in and download from the link provided below.

 
More articles :

» PDE-5 Inhibitors in Scleroderma Raynaud Phenomenon and Digital Ulcers: Current Status of Clinical Trials

Ann J. Impens, Kristine Phillips, and Elena SchiopuReceived 2 June 2011; Accepted 2 August 2011Phosphodiesterases (PDEs) are isoenzymes that control the level of intracellular cyclic guanosine monophosphate (cGMP) and cyclic adenosine monophosphate...

» Placebo-controlled Study of Methotrexate in Juvenile Localised Scleroderma

According to the results of this placebo-controlled study, is an effective treatment for juvenile localised scleroderma (JLS). The authors note that JLS is a chronic progressive fibrotic process of the skin causing permanent disability and...

» Calcium Deposits Under the Skin

Numerous health effects or conditions are associated with calcinosis or calcium deposits under the skin. According to the , calcinosis is the medical term for calcium deposits that can form under the skin or in the muscles. Calcium deposits in these...

» The FDA Approves IV Sildenafil for Hypertension

The FDA has approved an intravenous formulation of the pulmonary arterial hypertension drug sildenafil (Revatio) for patients who are temporarily unable to take the medication in its oral form. The tablet form of sildenafil was approved in 2005 to...

» Free the Free Radicals

We’re all used to hearing that everything we once thought was good for us is not. But even within that framework, the latest science about , free radicals and exercise is telling. As many of us have heard, free radicals are molecules created by...

» The registry of the German Network for Systemic Scleroderma

N. Hunzelmann, E. Genth, T. Krieg, W. Lehmacher, I. Melchers, M. Meurer, P. Moinzadeh, U. Mu¨ ller-Ladner, C. Pfeiffer, G. Riemekasten, E. Schulze-Lohoff, C. Sunderkoetter, M. Weber, M. Worm, P. Klaus, A. Rubbert, K. Steinbrink, B. Grundt, R. Hein,...

Add comment

Do feel free to leave your comments, as they would add value and knowledge to the community. However, please refrain from making any disparaging, uninformed, or unrelated comments. Thanks :)

Security code
Refresh