Left atrial volume and N-terminal pro-B type natriuretic peptide are associated with elevated pulmonary artery pressure in patients with systemic sclerosis

Abstract

Early detection of pulmonary hypertension (PH) in patients with systemic sclerosis (SSc) is essential as it leads to substantial morbidity and mortality irrespective of its etiology. The aim of our study was to determine whether noninvasive biochemical and/or echocardiographic indices can predict the presence of PH in these patients. We prospectively studied 66 patients (mean age of 57.7 +/- 12.1 years, 63 women) with SSc without clinical manifestations of heart failure. All patients underwent standard and tissue Doppler echocardiography. Plasma N-terminal pro-B type natriuretic peptide (NT-proBNP) and asymmetric dimethylarginine (ADMA) levels were also measured. In 24 (36%) patients, the diagnosis of PH was established by echocardiography (systolic pulmonary artery pressure value > or =40 mmHg). Left atrial (LA) volume, NT-proBNP, ADMA, ratio of early transmitral filling velocity to early diastolic velocity of the mitral annulus (mitral E/E (m)), and right ventricular myocardial performance index (MPI) were univariate predictors of PH. In multivariate analysis, NT-proBNP, LA volume, and right ventricular MPI were independent predictors of PH in SSc patients. LA volume and NT-proBNP may be useful noninvasive markers for the prediction of elevated pulmonary artery pressure in patients with SSc. These parameters should be considered when assessing this population for risk stratification and for identification of patients demanding further investigation and institution of specific therapy for the disease at the time when it is most likely to be effective.

Evaluation of left atrial volume and function in systemic sclerosis patients using speckle tracking and real-time three-dimensional echocardiography

“…Fisher et al (25) reported that LA dimensions were significantly larger in SSc patients with PHT than in idiopathic PHT patients and suggested that this observation is a reflection of increased prevalence of LVDD in SSc patients. Dimitroulas et al (26) has also recently reported that Vmax is a strong independent predictor of the presence of PHT at rest in a small cohort of SSc patients using 2D echocardiography. The etiology of PHT in SSc patients seems to be multifactorial, and it has been reported that there is a high incidence of postcapillary PHT in SSc patients (27).…”

Left atrial dysfunction detected by speckle tracking in patients with systemic sclerosis

“…However, many of these alterations can be intercepted earlier by means of changes of the LA regional mechanical characteristics and function. A few previous studies had evaluated LA characteristics in SSc patients: Dimitroulas et al showed that LA volume may be a useful noninvasive marker for the prediction of elevated pulmonary artery pressure in these patients [56]; impairment of electromechanical LA functions, including a prolonged intra-interatrial electromechanical delay and higher P-wave dispersion was also found in SSc patients, compared to a control group, confirming the increased risk of these patients for developing supraventricular arrhythmias [56]. …”

Serum endothelin-1 and NT-proBNP, but not ADMA, endoglin and TIMP-1 levels, reflect impaired right ventricular function in patients with systemic sclerosis

“…Similar to our findings, they revealed significantly increased serum NT-proBNP level in SSc patients with echocardiographic signs of PH (370.5 [224.9–606.7] vs 256.1 [197.3–351.7] fmol/l, p  = 0.012) (179). NT-proBNP (OR per 10 fmol/l increase 1.03; 95 % CI 1.00–1.05) was the univariate correlate of the presence of PH [5]. …”

“…Potentially, identification of noninvasive predictors of right ventricular (RV) dysfunction may allow early detection of cardiac involvement and may help to select patients for further invasive evaluation [5]. Echocardiography is a widely available noninvasive diagnostic tool for RV dysfunction detection.…”