High N‐terminal pro–brain natriuretic peptide levels and low diffusing capacity for carbon monoxide as independent predictors of the occurrence of precapillary pulmonary arterial hypertension in patients with systemic sclerosis

Abstract

Objective. To evaluate predictors of pulmonary arterial hypertension (PAH) in a prospective cohort of patients with systemic sclerosis (SSc).Methods. Routine clinical assessments as well as measurements of the diffusing capacity for carbon monoxide/alveolar volume (DLCO/VA) ratio and N-terminal pro-brain natriuretic peptide (NT-proBNP) level were performed in a prospective cohort of 101 SSc patients who did not have PAH or severe comorbidities. After a planned 36-month followup, we evaluated the predictive value of these parameters for the development of precapillary PAH, as demonstrated by cardiac catheterization, disease progression, and death. Criteria for cardiac catheterization were a systolic pulmonary artery pressure (PAP) of >40 mm Hg on echocardiography, a DLCO value of <50% without pulmonary fibrosis, and unexplained dyspnea. Conclusion. This prospective study identified a decreased DLCO/VA ratio and an increased NT-proBNP as predictors of PAH in SSc. Use of these markers should result in improved PAH risk stratification and allow earlier initiation of therapy.

Contribution of Speckle Tracking to Estimation of Pulmonary Hypertension by Standard Doppler Echocardiography in Patients with Systemic Sclerosis and MCTD

“…Thus, NT-proBNP and DLCO now belong to the most useful predictors of pulmonary hypertension in SSc patients [20,21]. Regarding differences between limited or diffuse SSc and MCTD in the present study, patients with MCTD were significant younger than SSc patients and patients with diffuse SSc had significant lower total lung capacity and DLCO than those with limited SSc or MCTD.…”

Biomarkers in Systemic Sclerosis

“…Recent interest has also been focused on the measurement of plasma levels of NT-pro-BNP. Although the plasma levels of this peptide reflect myocardial responses to various stimuli, such as mechanical stretch or hypoxia and are not specific for PAH, plasma NT-pro-BNP determinations may predict prospectively the development of clinical PAH, and may also be indicative of survival and represent an accurate surrogate marker to follow the response and evaluate the effects of therapeutic agents for SSc-related PAH [64][65][66][67][68].…”

Practical approach to screening for scleroderma‐associated pulmonary arterial hypertension

“…Elevated BNP or NT-proBNP levels are surrogate biomarkers for myocardial disease and are frequently elevated in patients with SSc-PAH (53)(54)(55)(56). They may be useful as an adjunctive component of SSc-PAH screening tools, with a caveat that early patients without significant right-sided heart failure will have normal values.…”