N-terminal pro-brain natriuretic peptide is a strong predictor of mortality in systemic sclerosis

作者：Allanore Yannick; Komocsi Andras; Vettori Serena; Hachulla Eric; Hunzelmann Nicolas; Distler Jorg; Avouac Jerome; Gobeaux Camille; Launay David; Czirjak Laszlo; Kahan Andre; Meune Christophe^*

来源：International Journal of Cardiology, 2016, 223: 385-389.

DOI：10.1016/j.ijcard.2016.08.246

• N-terminal pro-brain natriuretic peptide
• Systemic sclerosis
• Pulmonary artery hypertension
• Cardiovascular mortality

Objectives: Cardiovascular involvement is a major contributor to mortality in systemic sclerosis (SSc). We examined whether N-terminal pro-brain natriuretic peptide (NT-proBNP) is a reliable predictor of mortality in SSc.
Methods and results: This multicentre prospective cohort study included 523 patients presenting with SSc, whose mean age was 54 +/- 13 years, mean disease duration 8 +/- 9 years, and diffuse cutaneous form in 168. Plasma NT-proBNP was measured at baseline and the patients were followed yearly. Overall mortality was measured at 3 years. At baseline, cardiovascular involvement was present in 37 patients, including 17 with pulmonary artery hypertension (PAH) and 20 with a left ventricular ejection fraction (LVEF) <55%. At 3 years, 32 (7%) patients had died. The median [25th-75th percentile] NT-proBNP concentration was 203 ng/l [129-514] in patients who died within 3 years, versus 88 ng/l [47-167] in survivors (P < 0.001). NT-proBNP was an independent predictor of 3-years mortality in multivariate analysis (P = 0.046). The optimal cut-off derived from the ROC curve was 129 ng/l; sensitivity and specificity to predict 3 y mortality were 78.1 and 66.7%. Using the previously recommended 125-ng/l concentration as threshold value, NT-proBNP reliably and independently predicted 3 year mortality, with a sensitivity of 78.1 and a negative predictive value of 97.6%, respectively (P = 0.006). The consideration of SSc patients without PAH or LVEF < 55% at baseline yielded similar results.
Conclusion: NT-proBNP appears as a reliable and independent predictor of mortality in patients with SSc.

• 出版日期2016-11-15