B-Type Natriuretic Peptide as a Marker of Different Forms of Systemic Sclerosis

Abstract

SummaryBackgroundSystemic sclerosis (SSc) is an autoimmune connective tissue disease which affects various tissues and organs, including skin, lungs, kidneys, gastrointestinal tract and cardiovascular system. Cardiac involvement is the most commonly recognized problem and a significant cause of morbidity. The brain natriuretic peptide (BNP) is a previously known marker of elevated cardiovascular risk in SSc, but the levels of BNP in various forms of SSc have not been investigated so far.AimThe aim of our study was to evaluate the influence of SSc on the function of the right ventricle and the right atrium using the echocardiographic parameters. Moreover, we examined the levels of BNP in different forms of SSc as well as the association of disease severity with the plasma concentrations of BNP.MethodsWe included 42 patients with newly diagnosed SSc and patients whose disease had been diagnosed earlier. SSc patients and non-SSc control patients were examined by using echocardiography and the concentrations of BNP were determined.ResultsWe analyzed differences in the parameters of right ventricle (RV) function and right atrium (RA) function between SSc patients and healthy controls. The two groups had similar distribution of gender, but SSc patients were significantly older than controls. RV wall thickness was increased in SSc patients (p<0.001), while right ventricular end-systolic area (RVESA; p=0.408) and right ventricular end-diastolic area (RVEDA; p=0.368) did not differ among the examinees. In contrast, RA minor-axis dimension (p=0.001) and the tricuspid annular plane systolic excursion (TAPSE) (p=0.001) were significantly higher in SSc patients. Also, we analyzed differences in brain natriuretic peptide (BNP) concentrations between diffuse cutaneous systemic sclerosis (DSSc) and limited cutaneous systemic sclerosis (LSSc) patients. DSSc patients had significantly higher concentrations of BNP. We found that levels of BNP were in significant positive correlations with age (p=0.007), disease duration (p=0.023), C reactive protein (CRP) (p=0.032), right ventricle fractional area change (FAC) (p=0.022), pulmonary vascular resistance (PVR) and Rodnan score (p=0.019).ConclusionsGiven the obtained results, the laboratory determination of BNP could be useful in differentiating different forms of systemic sclerosis as well as in predicting the severity of the disease and future cardiovascular complications.

Systemic sclerosis – multidisciplinary disease: clinical features and treatment

“…The first symptoms of heart involvement usually point to a poor prognosis and are an independent mortality risk factor and account for 20% of deaths in patients with SSc [45]. Therefore SSc heart involvement should be diagnosed as early as possible, during the asymptomatic period in particular.…”

“…There have been many studies conducted on finding a proper serum marker of SSc heart involvement useful in diagnosis at early stages of the disease, with both brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) being investigate [45]. Both BNP and NT-proBNP are elevated in patients with systemic sclerosis related pulmonary hypertension and may be considered as markers of early pulmonary arterial hypertension.…”

Consensus on the assessment of systemic sclerosis–associated primary heart involvement: World Scleroderma Foundation/Heart Failure Association guidance on screening, diagnosis, and follow-up assessment

“…Higher levels of cardiac-specific laboratory biomarkers, such as NT-proBNP and Troponin I, have been observed in SSc patients compared to healthy controls [34][35][36][37] Studies using CMR and sTTE confirmed that all cardiac chambers and structures may be involved in SSc-pHI, with abnormalities of myocardial wall motion, contractility, and relaxation reported. In addition, sTTE has demonstrated significantly abnormal values of right ventricular function and tissue Doppler data, [38][39][40][41][42][43] while CMR data were consistent with histopathological evaluation of endomyocardial biopsy and autopsy samples, indicating inflammatory and fibrotic tissue changes. 19,34,[44][45][46][47][48] ECG studies have detected a meaningful number of arrhythmias, although the definition ranged from benign isolated ectopics to major malignant ventricular arrhythmias, and no studies have compared an SSc group with matched healthy controls or between cardiac involved and noninvolved SSc patients.…”

Changes in the proteomic profile of blood serum in coronary atherosclerosis

“…The released C5b remains fixed on the membrane and sequentially binds C6, C7, C8, and C9, thereby forming a membrane-attacking complex that lyses the target cell by forming a transmembrane channel (1). It is known that the complement system is activated in atherosclerosis and CVD (2,3).…”

“…Proteins of the complement system, which is the most important factor of microbial resistance of the human body, take part in immune response (1). Many studies show activation of the complement system in atherosclerosis (1)(2)(3). Ceruloplasmin is a specific plasma glycoprotein that belongs to the family of acute phase proteins, has pro-and anti-inflammatory properties, and therefore its involvement in atherosclerosis is a controversial topic.…”