Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/73620
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Type: Journal article
Title: N-terminal pro-brain natriuretic peptide in a novel screening algorithm for pulmonary arterial hypertension in systemic sclerosis: a case-control study
Author: Thakkar, V.
Stevens, W.
Prior, D.
Moore, O.
Byron, J.
Liew, D.
Patterson, K.
Hissaria, P.
Roddy, J.
Zochling, J.
Sahhar, J.
Nash, P.
Tymms, K.
Celermajer, D.
Gabbay, E.
Youssef, P.
Proudman, S.
Nikpour, M.
Citation: Arthritis Research & Therapy, 2012; 14(3):1-10
Publisher: BioMed Central Ltd.
Issue Date: 2012
ISSN: 1478-6354
1478-6362
Statement of
Responsibility: 
Vivek Thakkar, Wendy M. Stevens, David Prior, Owen A. Moore, Jillian Byron, Danny Liew, Karen Patterson, Pravin Hissaria, Janet Roddy, Jane Zochling, Joanne Sahhar, Peter Nash, Kathleen Tymms, David Celermajer, Eli Gabbay, Peter Youssef, Susanna M. Proudman and Mandana Nikpour
Abstract: INTRODUCTION: Pulmonary arterial hypertension is a major cause of mortality in systemic sclerosis. N-terminal probrain natriuretic peptide (NT-proBNP) has emerged as a candidate biomarker that may enable the early detection of systemic sclerosis-related pulmonary arterial hypertension (SSc-PAH). The objective of our study was to incorporate NT-proBNP into a screening algorithm for SSc-PAH that could potentially replace transthoracic echocardiography (TTE) as a more convenient and less costly “first tier” test. METHODS: NT-proBNP levels were measured in patients from four clinical groups: a group with right heart catheter (RHC)-diagnosed SSc-PAH before commencement of therapy for PAH; a group at high risk of SSc-PAH based on TTE; a group with interstitial lung disease; and systemic sclerosis (SSc) controls with no cardiopulmonary complications. NT-proBNP levels were compared by using ANOVA and correlated with other clinical variables by using simple and multiple linear regression. ROC curve analyses were performed to determine the optimal cut point for NT-proBNP and other clinical variables in prediction of PAH. RESULTS: NT-proBNP was highest in the PAH group compared with other groups (P < 0.0001), and higher in the risk group compared with controls (P < 0.0001). NT-proBNP was positively correlated with systolic pulmonary artery pressure (PAP) on TTE (P < 0.0001), and mean PAP (P = 0.013), pulmonary vascular resistance (P = 0.005), and mean right atrial pressure (P = 0.006) on RHC. A composite model wherein patients screened positive if NT-proBNP was ≥ 209.8 pg/ml, and/or DLCOcorr was < 70.3% with FVC/DLCOcorr ≥ 1.82, had a sensitivity of 100% and specificity of 77.8% for SSc-PAH. CONCLUSION: We have proposed a screening algorithm for SSc-PAH, incorporating NT-proBNP level and PFTs. This model has high sensitivity and specificity for SSc-PAH and, if positive, should lead to TTE and confirmatory testing for PAH. This screening algorithm must be validated prospectively.
Keywords: Humans; Hypertension, Pulmonary; Scleroderma, Systemic; Natriuretic Peptide, Brain; Peptide Fragments; Biological Markers; Early Diagnosis; Area Under Curve; Sensitivity and Specificity; Case-Control Studies; ROC Curve; Age of Onset; Algorithms; Adult; Aged; Middle Aged; Female; Male
Rights: © 2012 Thakkar et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
RMID: 0020121893
DOI: 10.1186/ar3876
Published version: http://arthritis-research.com/content/14/3/R143
Appears in Collections:Medicine publications

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