Session Information
Title: Systemic Sclerosis, Fibrosing Syndromes, and Raynaud’s - Clinical Aspects and Therapeutics II
Session Type: Abstract Submissions (ACR)
Background/Purpose: Pulmonary arterial hypertension (PAH) is a major cause of mortality in systemic sclerosis (SSc), and alterations in nitric oxide (NO) metabolism and endothelial cell function are implicated in the pathogenesis of SSc-PAH. Asymmetric dimethlyarginine (ADMA) is a novel biomarker of endothelial cell dysfunction. In this study, the clinical utility of ADMA as a screening biomarker for incident SSc-PAH was evaluated
Methods: ADMA levels were measured in 15 consecutive treatment-naive subjects with newly-diagnosed SSc-PAH, and compared with 30 SSc-controls without PAH. ADMA levels were assayed using high performance liquid chromatography with solid phase extraction. N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were measured in the same subjects. Logistic regression models were used to evaluate the independent association of ADMA with PAH. Important correlations of ADMA were assessed using Spearman’s rank correlation coefficient (rho). The optimal cut-points of ADMA and NT-proBNP that maximised desired test properties for screening were determined
Results: The PAH group had significantly higher mean ADMA levels than the control group (0.76 ± 0.14 μM versus 0.59 ± 0.07 μM; p <0.0001). ADMA levels remained significantly associated with PAH after the adjustment for specific disease characteristics, cardiovascular risk factors and other SSc-related vascular complications (all p <0.01). An ADMA level ≥0.694 μM had a sensitivity of 86.7%, specificity of 90.0% and AUC of 0.86 for diagnosing PAH. An NT-proBNP level ≥209.8ng/mL had a sensitivity of 93.3%, specificity of 100% and AUC of 0.94 for diagnosing PAH. A ‘purely’ biomarker based screening model that combined an NT-proBNP ≥209.8ng/mL and/or ADMA ≥0.694 ng/mL resulted in a sensitivity of 100% and specificity of 90% for the detection of SSc-PAH.
Conclusion: ADMA may be an important screening biomarker for SSc-PAH. A composite ‘purely’ biomarker-based screening algorithm, using NT-proBNP in combination with ADMA, may achieve an excellent sensitivity (and also specificity) for the non-invasive identification of SSc-PAH.
Disclosure:
V. Thakkar,
None;
W. Stevens,
None;
D. Prior,
None;
J. Sahhar,
None;
J. E. Roddy,
None;
J. Zochling,
None;
P. Nash,
None;
P. Youssef,
None;
S. Proudman,
None;
M. Nikpour,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/asymmetric-dimethylarginine-levels-in-the-early-detection-of-systemic-sclerosis-related-pulmonary-arterial-hypertension/