title: NT-proatrial natriuretic peptide as a possible biomarker of cardiopulmonary involvement in sarcoidosis.
abstract: BACKGROUND
  Lung diffusion for carbon monoxide (DLCO) has been shown to associate with the risk of pulmonary arterial hypertension development and, most likely, with right ventricular (RV) myocardial dysfunction in sarcoidosis patients. Besides its known role as a marker of left ventricular dysfunction, experimental evidence suggests a role of NT-proAtrial Natriuretic Peptide (NT-proANP) also in modulating pulmonary circulation. We therefore investigated possible relationships between NT-proANP, lung diffusion impairment and RV dysfunction.
  
  
  METHODS
  Thirty-two pulmonary sarcoidosis outpatients and eighteen volunteers underwent full clinical assessment, including full lung function tests and Doppler echocardiography integrated with tissue Doppler imaging (TDI) study. Resting circulating NT-proBNP and NT-proANP plasma levels were also determined.
  
  
  RESULTS
  NT-proANP and RV-myocardial performance index (RV-MPI) were significantly higher in those patients with the greatest DLCO impairment, whereas no differences were found for NT-proBNP values. At multivariable analysis, only DLCO (β: -0.496; standard error: 3.38; p=0.000) and RV-MPI (β: 0.373; standard error: 6.56; p=0.031) remained significantly associated with NT-proANP levels.
  
  
  CONCLUSIONS
  Our finding may support a key role of NT-proANP in the complex mechanisms underlying modulation of lung function. An early increase in pulmonary vascular resistance may stimulate NT-proANP increase, thus explaining its association with signs of early RV myocardial dysfunction. This hypothesis warrants further confirmation.
authors.affiliation: Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.
authors.forename: Damiano
authors.initials: D
authors.lastname: Magrì
authors.forename: Piergiuseppe
authors.initials: P
authors.lastname: Agostoni
authors.forename: Agnese
authors.initials: A
authors.lastname: Ricotta
authors.forename: Lara
authors.initials: L
authors.lastname: Pisani
authors.forename: Filippo Maria
authors.initials: FM
authors.lastname: Cauti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Onofri
authors.forename: Pierdonato
authors.initials: P
authors.lastname: Bruno
authors.forename: Alberto
authors.initials: A
authors.lastname: Ricci
authors.forename: Massimo
authors.initials: M
authors.lastname: Volpe
authors.forename: Simona
authors.initials: S
authors.lastname: Marchitti
authors.forename: Salvatore
authors.initials: S
authors.lastname: Mariotta
authors.forename: Speranza
authors.initials: S
authors.lastname: Rubattu
mesh_terms: D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D015150:Echocardiography, Doppler / Q000379:methods; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011498:Protein Precursors / Q000097:blood*; D012129:Respiratory Function Tests / Q000379:methods; D012507:Sarcoidosis / Q000150:complications*; D014655:Vascular Resistance; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology
chemical_list: D015415:Biomarkers; C099254:N-terminal proatrial natriuretic peptide; D011498:Protein Precursors; D009320:Atrial Natriuretic Factor