Atrial natriuretic peptide predicts disease progression and digital ulcers development in systemic sclerosis patients

J Cardiovasc Med (Hagerstown). 2019 Nov;20(11):771-779. doi: 10.2459/JCM.0000000000000852.

Abstract

Aims: Systemic sclerosis (SSc) is an autoimmune disease characterized by micro/macrovascular damage due to the underlying fibrosis. Markers able to predict the progression of cardiovascular damage, including digital ulcers, in SSc are warranted. We aimed at characterizing the relevance of N-terminal proatrial natriuretic peptide (NT-proANP) and N-terminal probrain natriuretic peptide plasma levels in relation to cardiovascular damage and digital ulcers in a cohort of Italian SSc patients.

Methods: Seventy patients were enrolled (64 women and six men; mean age 56.7 ± 14 years) with a disease duration of 11.1 ± 8.3 years. Clinical, instrumental (nailfold videocapillaroscopy, ECG, transthoracic echocardiography, pulmonary function test with diffusion lung CO), NT-proANP and N-terminal probrain natriuretic peptide plasma levels measurement were performed at baseline. The clinical follow-up lasted 24 months. The statistical approach used to achieve the study objectives included multivariate analysis, receiver operating characteristic curve, Kaplan-Meier and Cox regression analyses.

Results: Both NT-proNPs levels correlated with systolic pulmonary arterial pressure, but only the NT-proANP level correlated with right heart dimension. Both NT-proNPs levels were higher in patients experiencing events at follow-up but only the NT-proANP level significantly predicted the progression of cardiovascular damage, including development of pulmonary arterial hypertension (PAH). NT-proANP levels were higher in patients with digital ulcers and strongly predicted their development.

Conclusion: Our results show that the NT-proANP plasma level significantly correlates with disease progression such as new onset of PAH, worsening of pulmonary hypertension and development of digital ulcers in a cohort of SSc Italian patients. If future studies will confirm our findings, the plasma NT-proANP level could be used in clinical practice as a novel sensitive marker for PAH and digital ulcers development in SSc.

MeSH terms

  • Adult
  • Aged
  • Atrial Natriuretic Factor / blood*
  • Biomarkers / blood
  • Disease Progression
  • Female
  • Humans
  • Italy
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood
  • Peptide Fragments / blood*
  • Predictive Value of Tests
  • Prognosis
  • Pulmonary Arterial Hypertension / blood*
  • Pulmonary Arterial Hypertension / diagnosis
  • Pulmonary Arterial Hypertension / etiology
  • Scleroderma, Systemic / blood*
  • Scleroderma, Systemic / complications
  • Scleroderma, Systemic / diagnosis
  • Skin Ulcer / blood*
  • Skin Ulcer / diagnosis
  • Skin Ulcer / etiology
  • Up-Regulation

Substances

  • Biomarkers
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain
  • Atrial Natriuretic Factor