Disproportionate elevation of N-terminal pro-brain natriuretic peptide in scleroderma-related pulmonary hypertension

S. C. Mathai, M. Bueso, L. K. Hummers, D. Boyce, N. Lechtzin, J. Le Pavec, A. Campo, H. C. Champion, T. Housten, P. R. Forfia, A. L. Zaiman, F. M. Wigley, R. E. Girgis, P. M. Hassoun

Research output: Contribution to journalArticle

Abstract

N-terminal pro-brain natriuretic peptide (NT-proBNP) is a marker of neurohormonal activation that is useful in the diagnosis and prognosis of various forms of pulmonary arterial hypertension (PAH). We sought to characterise and compare NT-proBNP in a cohort of PAH related to systemic sclerosis (PAH-SSc) and idiopathic PAH (IPAH) patients. NT-proBNP levels, collected from PAH-SSc and IPAH patients followed prospectively, were compared and correlated with haemodynamic variables. Cox proportional hazard models were created to assess the predictive value of NT-proBNP. 98 patients (55 PAH-SSc, 43 IPAH) were included. Haemodynamics were similar, except for lower mean pulmonary arterial pressure in PAH-SSc. NT-proBNP levels were significantly higher in PAH-SSc (3,419±3,784 versus 1,393±1,633 pg?mL -1; p<0.01) and were more closely related to haemodynamics in PAH-SSc than IPAH. 28 patients died. NT-proBNP predicted survival (hazard ratio (HR) 3.18; p<0.01) in the overall cohort; however, when stratified by group, predicted survival only in PAH-SSc (HR 3.07, p<0.01 versus 2.02, p=0.29 in IPAH). This is the first description showing NT-proBNP levels are 1) significantly higher in PAH-SSc than IPAH despite less severe haemodynamic perturbations, and 2) stronger predictors of survival in PAH-SSc, suggesting that neurohormonal regulation may differ between PAH-SSc and IPAH. Future studies to define pertinent mechanisms are warranted. Copyright

Original languageEnglish (US)
Pages (from-to)95-104
Number of pages10
JournalEuropean Respiratory Journal
Volume35
Issue number1
DOIs
StatePublished - Jan 1 2010

    Fingerprint

Keywords

  • Prognostic markers
  • Pulmonary hypertension
  • Scleroderma

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this