Open AccessHigh 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
Author(s) -
Allanore Y.,
Borderie D.,
Avouac J.,
Zerkak D.,
Meune C.,
Hachulla E.,
Mouthon L.,
Guillevin L.,
Meyer O.,
Ekindjian O. G.,
Weber S.,
Kahan A.
Publication year - 2008
Publication title -
arthritis & rheumatism
Language(s) - English
Resource type - Journals
eISSN - 1529-0131
pISSN - 0004-3591
DOI - 10.1002/art.23187
Subject(s) - medicine , cardiology , hazard ratio , prospective cohort study , natriuretic peptide , diffusing capacity , pulmonary artery , pulmonary hypertension , brain natriuretic peptide , cohort , heart failure , confidence interval , lung , lung function
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 (DL CO /V A ) 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 DL CO value of <50% without pulmonary fibrosis, and unexplained dyspnea. Results Eight patients developed PAH, 29 had disease progression, and 10 died during a median followup of 29 months. Kaplan‐Meier analysis identified the following baseline parameters as being predictors of PAH: DL CO /V A ratio <70% or <60% ( P < 0.01 for each comparison), elevated plasma NT‐proBNP level (>97th percentile of normal; P = 0.005), echocardiographically estimated systolic PAP >40 mm Hg ( P = 0.08), and erythrocyte sedimentation rate >28 mm/hour ( P = 0.015). In multivariate analyses, an elevated baseline NT‐proBNP level (hazard ratio [HR] 9.97 [95% confidence interval (95% CI) 1.69–62.42]) and a DL CO /V A ratio <60% (HR 36.66 [95% CI 3.45–387.6]) were predictors of the occurrence of PAH during followup. An increased NT‐proBNP level together with a decreased DL CO /V A ratio of <70% was highly predictive of the occurrence of PAH during followup (HR 47.20 [95% CI 4.90–450.33]). Conclusion This prospective study identified a decreased DL CO /V A 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.