Diagnostic value of cardiac natriuretic peptide on pulmonary hypertension in systemic sclerosis: A systematic review and meta-analysis

Current Trends in Vascular Biomarkers for Systemic Sclerosis: A Narrative Review

“…Several studies have been conducted to evaluate the utility of NT-proBNP concentrations as a screening tool for SSc-related PAH [ 243 , 244 , 245 , 246 , 247 , 248 , 249 , 250 , 251 , 252 , 253 ]. A systematic review and meta-analysis through PubMed, Embase, and Cochrane Library databases was recently performed to estimate the diagnostic accuracy of serum NT-proBNP measurement in the clinical setting of SSc-PAH [ 254 ]. In this meta-analysis, involving many of the aforementioned studies [ 244 , 245 , 246 , 247 , 248 , 251 , 252 , 253 ], the pooled sensitivity and specificity of NT-proBNP to diagnose SSc-PAH were found to be 0.84 and 0.68, respectively, revealing that NT-proBNP has certain diagnostic value for PAH due to its better specificity and moderate sensitivity.…”

“…In this meta-analysis, involving many of the aforementioned studies [ 244 , 245 , 246 , 247 , 248 , 251 , 252 , 253 ], the pooled sensitivity and specificity of NT-proBNP to diagnose SSc-PAH were found to be 0.84 and 0.68, respectively, revealing that NT-proBNP has certain diagnostic value for PAH due to its better specificity and moderate sensitivity. However, although elevated serum NT-proBNP levels could warn clinicians of the occurrence of PAH, echocardiography and right heart catheterization should be conducted appropriately for further diagnosis [ 254 ].…”

Biomarkers in Systemic Sclerosis: An Overview

“…PAH is due to vasculopathy of the small and medium calibre pulmonary arteries (pulmonary arterial hypertension) which leads to vascular remodelling and to increase in pulmonary vascular resistance (PVR). PAH occurs in 7% to 19% of SSc patients depending on the population and duration of the disease [116][117][118][119][120][121]. The diagnosis of PAH is often made at a late stage, as in the early stages' patients may be asymptomatic or complain of nonspecific symptoms.…”

“…Therefore, patients with SSc should be screened for PAH, even if asymptomatic, by cardiac echocolordoppler, respiratory testing, and NT-ProBNP assay. Diagnostic algorithms have been proposed to identify patients for RHC, which is still the gold standard tool for diagnosing PAH and PH [116][117][118][119][120][121][122][123][124][125][126]. Risk factors for PAH include severe Raynaud's phenomenon, severe digital ischemia, cutaneous telangiectasias, chronic disease, late onset of the disease, advanced age, postmenopausal status, reduced diffusing capacity (DLCO < 50%), DLCO/alveolar volume less than 70%, forced vital capacity/DLCO less than 1.6, and increased right ventricular systolic pressure greater than 2 mmHg/year [110][111][112][113][114][115][116][117][118][119].…”

“…Screening should include specific autoantibodies (anti-topoisomerase I (SCL-70), an-ticentromere and anti-RNA polymerase III and antiphospholipid antibodies), pulmonary function tests, echocardiography, pro-terminal brain natriuretic peptide (NT-proBNP), capillaroscopy of nail folds and initial high-resolution CT scan to rule out ILD, and, in case of PAH, right heart catheterization to determine PA pressure [118][119][120][121][122][123][124][125][126]151]. Many molecules have been associated with vascular complications of SSc, so there are many potential biomarkers for vascular disease and PAH in SSc.…”