Role of N-terminal pro-brain natriuretic peptide in detecting clinically significant cardiac involvement in systemic sclerosis patients.
OBJECTIVE
Cardiac involvement is recognised as a poor prognostic factor among systemic sclerosis (SSc) patients, contributing significantly to mortality. We assessed the role of N-TproBNP in SSc-related cardiac involvement in a retrospective cohort of patients.


METHODS
Serum N-TproBNP levels were measured in 21 SSc patients with clinically significant cardiac involvement and in a control group of 42 SSc patients without any evidence of heart involvement. All patients had normal pulmonary artery systolic pressure and none had serum creatinine above 140 micromol/L.


RESULTS
Compared with those without cardiac involvement, N-TproBNP was significantly increased in SSc patients with heart involvement (median 11 and 219 pmol/L respectively, p<0.0001; CI 136-445). Receiver operating characteristic curves of N-TproBNP to predict the presence of cardiac involvement in SSc gave a sensitivity of 90.5% at a cut-off level of 50 pmol/L, with a specificity of 97.6%. By logistic regression analysis, N-TproBNP levels of 50 pmol/L were shown to be a strong predictor of heart involvement (OR 78, p<0.001, 95%CI 14-424). Moreover, a significant progressive reduction in N-TproBNP after initial presentation of cardiac involvement was observed in a subset of patients during 6 months of follow-up (p=0.023). Levels of N-TproBNP above the median value of 219 pmol/L did not predict survival (p=0.895, by log-rank). N-TproBNP levels strongly correlated negatively with LVEF (r=-0.7384, p=0.0002).


CONCLUSIONS
These data suggest N-TproBNP peptide may be a surrogate marker for cardiac involvement in SSc, selectively identifying patients with severe impairment of cardiac function.
IRCSS Istituto Auxologico Italiano, University of Milan, Milan, Italy. cecianda@hotmail.com
Cecilia
C
Chighizola
Pier Luigi
PL
Meroni
Benjamin E
BE
Schreiber
John G
JG
Coghlan
Christopher P
CP
Denton
Voon H
VH
Ong
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008131:London; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012595:Scleroderma, Systemic / Q000097:blood / Q000150:complications* / Q000401:mortality; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013318:Stroke Volume; D015854:Up-Regulation; D016277:Ventricular Function, Left
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain