The inclusion of N-terminal pro-brain natriuretic peptide in a sensitive screening strategy for systemic sclerosis-related pulmonary arterial hypertension: a cohort studyReportar como inadecuado




The inclusion of N-terminal pro-brain natriuretic peptide in a sensitive screening strategy for systemic sclerosis-related pulmonary arterial hypertension: a cohort study - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Arthritis Research and Therapy

, 15:R193

First Online: 19 November 2013Received: 15 April 2013Accepted: 07 November 2013

Abstract

IntroductionPulmonary arterial hypertension PAH is a major cause of mortality in systemic sclerosis SSc. Screening guidelines for PAH recommend multiple investigations, including annual echocardiography, which together have low specificity and may not be cost-effective. We sought to evaluate the predictive accuracy of serum N-terminal pro-brain natriuretic peptide NT-proBNP in combination with pulmonary function tests PFT ‘proposed’ algorithm in a screening algorithm for SSc-PAH.

MethodsWe evaluated our proposed algorithm PFT with NT-proBNP on 49 consecutive SSc patients with suspected pulmonary hypertension undergoing right heart catherisation RHC. The predictive accuracy of the proposed algorithm was compared with existing screening recommendations, and is presented as sensitivity, specificity, positive predictive value PPV and negative predictive value NPV.

ResultsOverall, 27 patients were found to have pulmonary hypertension PH at RHC, while 22 had no PH. The sensitivity, specificity, PPV and NPV of the proposed algorithm for PAH was 94.1%, 54.5%, 61.5% and 92.3%, respectively; current European Society of Cardiology ESC-European Respiratory Society ERS guidelines achieved a sensitivity, specificity, PPV and NPV of 94.1%, 31.8%, 51.6% and 87.5%, respectively. In an alternate case scenario analysis, estimating a PAH prevalence of 10%, the proposed algorithm achieved a sensitivity, specificity, PPV and NPV for PAH of 94.1%, 54.5%, 18.7% and 98.8%, respectively.

ConclusionsThe combination of NT-proBNP with PFT is a sensitive, yet simple and non-invasive, screening strategy for SSc-PAH. Patients with a positive screening result can be referred for echocardiography, and further confirmatory testing for PAH. In this way, it may be possible to shift the burden of routine screening away from echocardiography. The findings of this study should be confirmed in larger studies.

Abbreviations6MWDSix-minute walk distance

ANAAnti-nuclear antibody

anti-centAnti-centromere antibody

anti-Scl70Anti- topoisomerase-1 antibody

ASCSAustralian Scleroderma Cohort Study

BMIBody mass index

COCardiac output

DLCOcorrDiffusion capacity of lung for carbon monoxide, corrected for haemoglobin

eGFREstimated glomerular filtration rate

ESC-ERSEuropean Society of Cardiology-European Respiratory Society

FEV1Forced expiratory volume in one second

FVCForced vital capacity

FVC-DLCOForced vital capacity-diffusion capacity of lung for carbon monoxide, corrected for haemoglobin

HRCTHigh-resolution computed tomography

ILDInterstitial lung disease

LHDLeft heart disease

mPAPMean pulmonary artery pressure

mRAPMean right atrial pressure

NPVNegative predictive value

NT-proBNPN-terminal pro-brain natriuretic peptide

PAHPulmonary arterial hypertension

PCWPPulmonary capillary wedge pressure

PFTPulmonary function test

PHPulmonary hypertension

PPVPositive predictive value

pre-CPHPre-capillary pulmonary hypertension

PVRPulmonary vascular resistance

RHCRight heart catherisation

sPAPTTESystolic pulmonary artery pressure

SSc-PAHSystemic sclerosis-related pulmonary arterial hypertension

TRVTricuspid regurgitant velocity

TTETransthoracic echocardiography

V-QVentilation-perfusion

WHO-FCWorld Health Organization functional class.

Electronic supplementary materialThe online version of this article doi:10.1186-ar4383 contains supplementary material, which is available to authorized users.

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Autor: Vivek Thakkar - Wendy Stevens - David Prior - Peter Youssef - Danny Liew - Eli Gabbay - Janet Roddy - Jennifer G Walker -

Fuente: https://link.springer.com/







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