Session Information
Title: Systemic Sclerosis, Fibrosing Syndromes, and Raynaud’s - Clinical Aspects and Therapeutics II
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Pulmonary hypertension (PH) is a severe complication of systemic sclerosis (SSc), affecting 5-12% of patients. Despite recent progress in treatment, prognosis remains poor. Early therapeutic management and goal-oriented approach can improve long-term prognosis. Response to therapy is usually assessed by functional and hemodynamic parameters between 3-6 months after initiation of treatment. This study aimed to compare the changes in NT-proBNP with functional and hemodynamic parameters between baseline and 3-6 months after initiation of therapy.
Methods:
A retrospective study, undertaken in a National Pulmonary Hypertension Centre, identified patients diagnosed with SSc associated pre-capillary PH on right heart catheterisation (RHC) (mean pulmonary arterial pressure (mPAP) ≥ 25mmHg and pulmonary capillary wedge pressure (PCWP) ≤ 15mmHg) between 1998 and 2012 (n=600). Patients were included if they had a second RHC between 3 and 6 months after the initial RHC diagnosing PH and if NT-proBNP results were available within 30 days prior to each RHC. 53 patients were identified. 6 patients were excluded (glomerular filtration rate < 30 mL/min/1.73m2). Changes in variables (Δ) between baseline and 3-6 months were calculated in absolute value, percentage of variation and logarithm of each value. Pearson or Spearman methods were used to estimate correlation coefficient, where appropriate. Patients were divided into two groups: D=“NT-proBNP decreasing” and I/S=“NT-proBNP increasing or stable” according to the difference in NT-proBNP levels between baseline and repeat RHC. Survival analyses were performed using Kaplan-Meier method and log-rank test.
Results:
47 patients (42 female and 5 male) were included. 83% had limited cutaneous SSc and 53% were anti-centromere antibody positive. The mean age at diagnosis of PAH was 62.1 ± 11.5 years; the mean time between both RHCs was 3.6 ± 1.0 months and the mean follow-up after first RHC was 28.0 ± 15.4 months. Six-minute walking distance (6MWD – p=0.002), mPAP (p=0.003), cardiac index (p=0.034) and pulmonary vascular resistances (PVR – p<0.0001) significantly improved in the group D. There was a trend in decreasing for PVR in the I/S group (p=0.094). In the total population, ΔNT-proBNP was negatively correlated with Δ6MWD in percentage (R= -0.305, p=0.050). ΔNT-proBNP in percentage tended to correlate with ΔmPAP in percentage (p=0.090) or log (p=0.073). No correlation was found between ΔNT-proBNP in percentage or in log with PVR, cardiac output, cardiac index, venous oxygen saturation, right arterial pressure and PCWP. Survival was significantly better in patients with decreasing NT-proBNP in all patients with pre-capillary PH (p=0.045) and in patients with PAH (p=0.002). There was no difference for PH-ILD patients (p=0.658).
Conclusion: Patients with decreasing NT-proBNP presented a significant improvement in hemodynamic parameters at 3-6 months. No strong correlation was found between ΔNT-proBNP and changes in functional or hemodynamic variables. However, early changes in NT-proBNP seem to be associated with prognosis – especially in PAH patients.
Disclosure:
V. Sobanski,
None;
B. Lynch,
None;
B. E. Schreiber,
None;
C. Handler,
None;
C. P. Denton,
None;
J. G. Coghlan,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/can-changes-in-nt-probnp-predict-early-response-to-therapy-and-prognosis-in-systemic-sclerosis-associated-pre-capillary-pulmonary-hypertension/