title: NT-proBNP <95 ng/l can exclude pulmonary hypertension on echocardiography at diagnostic workup in patients with interstitial lung disease.
abstract: BACKGROUND
  Pulmonary hypertension (PH) is a serious complication to interstitial lung disease (ILD) and has a poor prognosis. PH is often diagnosed by screening with echocardiography followed by right heart catheterisation. A previous study has shown that a value of NT-pro-brain natriuretic peptide (NT-proBNP) <95 ng/l could be used to rule out PH in patients with ILD.
  
  
  OBJECTIVE
  To evaluate this rule-out test for PH in a new cohort of incident patients with ILD.
  
  
  METHODS
  An established database with data from 148 consecutive patients referred from January 2012 to October 2014 was used to identify patients and obtain data from echocardiography, NT-proBNP, diagnosis and lung function. Signs of PH on echocardiography were defined as a tricuspid pressure gradient (TR) ≥40 mmHg, decreased right ventricular systolic function or dilatation. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of NT-proBNP >95 ng/l for signs of PH on echocardiography were calculated. The study was approved by the Danish Health Authority.
  
  
  RESULTS
  In 118 patients, data from both echocardiography and measurements of NT-proBNP were available. Eleven of these were screened positive for PH on echocardiography. Sensitivity, specificity, NPV and PPV of NT-proBNP <95 ng/l for PH were 100, 44, 16 and 100%, respectively. Furthermore, no patients with left heart failure as the cause of dyspnoea were missed using this cut-off value.
  
  
  CONCLUSIONS
  NT-proBNP <95 ng/l precludes a positive echocardiographic screen for PH in ILD patients at referral for diagnostic workup.
authors.affiliation: Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark; cua@biomed.au.dk.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Andersen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Mellemkjær
authors.affiliation: Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Ole
authors.initials: O
authors.lastname: Hilberg
authors.affiliation: Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Bendstrup
keywords: IPF; biomarker; brain natriuretic peptides; cor pulmonale; diagnosis; idiopathic pulmonary fibrosis; lung fibrosis