title: Role of BNP and echo measurement for pulmonary hypertension recognition in patients with interstitial lung disease: An algorithm application model.
abstract: BACKGROUND
  This study evaluated the role of echocardiography and BNP in patients with interstitial lung disease (ILD), to identify those with PH and RV dysfunction. The aims of this study were: 1-to evaluate the accuracy of an algorithm including BNP, DLCO and echocardiographic measurements to identify PH and RV dysfunction; 2- to evaluate BNP and Echo values concordance in relation to right catheterization measurement.
  
  
  METHODS
  We analyzed 113 patients with diagnosis of ILD. Echo examination included: Pulmonary systolic, diastolic and mean Arterial Pressure (PAPs, PAPd, PAP mean), End-Diastolic and End-Systolic right ventricle diameters, Inferior Caval Vein diameter, and Tricuspid Annular Plane Systolic Excursion (TAPSE). Patients revealing increased PAPs at echocardiography underwent to catheterization.
  
  
  RESULTS
  Patients with PAPs > 40 mm Hg (37 patients), PAPmean ≥ 25 mm Hg (23 patients) and PAPd ≥ 20 mm Hg showed BNP increased (157 ± 96 vs 16 ± 14 pg/ml p = 0.004; 201 ± 120 vs 28 ± 17 pg/mL; 124 ± 88 vs 23 ± 18 pg/ml p < 0.001) as patients with TAPSE ≤16 mm (25 patients) (145 ± 104 vs 26 ± 21 pg/ml p < 0.001). In catheterized patients (37 patients) BNP was increased in patients with invasive PAPs > 40 mm Hg (165 ± 112 vs 29 ± 14 pg/ml p < 0.02), as well as in patients with Wedge pressure > 14 mm Hg (199 + 153 vs 54 + 39 pg/mL; p = 0.01). ROC Curve analysis showed that elevated values of BNP, PAPs, PAP mean are able to assess PH. On the other hand, lower values of DLCO (<40%) and TAPSE (≤16 mm) detect PH. Logistic regression analysis of the previous parameters, confirmed their diagnostic role in PH detection.
  
  
  CONCLUSIONS
  In patients with ILD, an algorithm including BNP, DLCO and echocardiography could be useful for non invasive screening of PH.
  ARTEMIS-HP trial; ID number: NCT00879229.
authors.affiliation: Department of Internal Medicine, Cardiology Unit, Le Scotte Hospital University of Siena, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Ruocco
authors.affiliation: UO Respiratory Diseases, University of Siena, Italy.
authors.forename: Behar
authors.initials: B
authors.lastname: Cekorja
authors.affiliation: UO Respiratory Diseases, University of Siena, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Rottoli
authors.affiliation: UO Respiratory Diseases, University of Siena, Italy.
authors.forename: Rosa Metella
authors.initials: RM
authors.lastname: Refini
authors.affiliation: Department of Internal Medicine, Cardiology Unit, Le Scotte Hospital University of Siena, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Pellegrini
authors.affiliation: Department of Internal Medicine, Cardiology Unit, Le Scotte Hospital University of Siena, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Di Tommaso
authors.affiliation: Department of Internal Medicine, Cardiology Unit, Le Scotte Hospital University of Siena, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Del Castillo
authors.affiliation: Department of Internal Medicine, Cardiology Unit, Le Scotte Hospital University of Siena, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Franci
authors.affiliation: Department of Internal Medicine, Cardiology Unit, Le Scotte Hospital University of Siena, Italy.
authors.forename: Ranuccio
authors.initials: R
authors.lastname: Nuti
authors.affiliation: Department of Internal Medicine, Cardiology Unit, Le Scotte Hospital University of Siena, Italy. Electronic address: palazzuoli2@unisi.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Palazzuoli
mesh_terms: D000368:Aged; D000465:Algorithms; D015415:Biomarkers / Q000097:blood; D003937:Diagnosis, Differential; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D007558:Italy / Q000453:epidemiology; D017563:Lung Diseases, Interstitial / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D018579:Patient Selection; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D062606:Tertiary Care Centers
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
keywords: BNP; Diagnostic methods; Interstitial lung disease; Pulmonary hypertension