Date: Sunday, November 8, 2015
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Heart involvement is common in Systemic Sclerosis (SSc), even if often clinically silent, and represents one of the leading cause of death in these patients. Recently it has been reported the role of NT-proBNP and high sensitivity Troponin T (cTnT) in patients with SSc-related pulmonary arterial hypertension (PAH), but their prognostic role is lacking in primary cardiac involvement. The aim of our study was to define the role of cardiac troponin T (cTnT) and NT-proBNP to identify cardiac involvement in SSc.
Methods: High sensitivity cTnT and NT-proBNP were measured in 200 consecutive SSc patients and in matched healthy controls. Patients with renal failure and with PAH on right heart catheterization were excluded. Data regarding disease subtype and organ involvement were available and all SSc-related deaths were registered. Classical cardiovascular risk factors were also considered. A mean follow-up of 48.6±20.6 months was reached.
cTnT levels and NT-proBNP values were higher in scleroderma patients (cTnT: 0.03±0.06 ng/ml and NTproBNP: 507.3±1718.9 pg/ml) than in healthy controls (cTnT: 0.006±0.0004 ng/ml and NT-proBNP: 90.6 ± 70.9, pg/ml,p<0.00001 for both comparisons).
cTnT levels were upper the normal limit in 65 SSc patients (32.5%), 72.6% complained cardiac symptoms, while 27.4% was completely asymptomatics. At multivariate analysis diffuse skin involvement (RR: 2.1 [1.2-4.4] and the presence of right bundle branch block (RBBB) on ECG (RR: 8.1 [1.4-45.5]) emerged as indipendent predictors of elevation of cTNT. NT-proBNP levels were above the cut-off limit of 125 ng/ml, recommended by the manufacturer, in 66 patients (33.3%), 72% of whom complained cardiac symptoms, while 28% was asymptomatic. Thirty-eight patients (19.0%) presented either an increase of cTnT either of NT-proBNP. At multivariate analysis diffuse skin involvement (RR: 2.3 [1.1-4.9]) and age (RR: 1.2 [1.03-1.09]) were indipendent predictors of elevation of NT-proBNP.
During the follow-up, 12 SSc-related death occurred; 8 of these were directly related to cardiac involvement (sudden cardiac death or heart failure). Cumulative survival estimated by Kaplan-Mayer curve was worse in patients with increased baseline levels of cTnT (Χ2=10.2, p=0.001) and NT-proBNP (Χ2=11.1, p=0.001), but patients with increase of cTnT and NT-proBNP had the worst outcome (Χ2=13.5, p=0.003).
cTnT and NT-proBNP are useful markers to identify symptomatic and asymptomatic SSc patients with a subclinical heart disease and a bad cardiac outcome.
To cite this abstract in AMA style:Bosello SL, De Luca G, Forni F, Di Mario C, parisi F, Canestrari G, Berardi G, Rucco M, Gabrielli F, Galiuto L, Loperfido F, Ferraccioli G. Troponin T and NT-Probnp Are Prognostic Cardiac Disease Biomarkers in Patients with Systemic Sclerosis without Pulmonary Arterial Hypertension [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/troponin-t-and-nt-probnp-are-prognostic-cardiac-disease-biomarkers-in-patients-with-systemic-sclerosis-without-pulmonary-arterial-hypertension/. Accessed February 28, 2020.
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