Cost savings with a novel algorithm for early detection of systemic sclerosis‐related pulmonary arterial hypertension: alternative scenario analyses

Application of Combined Detection of Echocardiography and Serum NT-ProBNP in the Diagnosis of Diastolic Heart Failure and Its Effect on Left Ventricular Morphology and Diastolic Function

Objective

This study is to assess the application of combined detection of echocardiography and serum N-terminal pro B-type natriuretic peptide (NT-ProBNP) in the diagnosis of diastolic heart failure (DHF) and its effect on left ventricular morphology and diastolic function.

Methods

Thirty patients with DHF with enrolled in our hospital between January 2019 and January 2021 were included in the experimental group, and thirty healthy individuals during the same period were included in the control group. The blood pressure, heart rate (HR), left ventricular morphology, diastolic function, and serum NT-ProBNP levels were compared between the two groups.

Results

DHF was associated with higher levels of diastolic blood pressure (DBP), systolic blood pressure (SBP), HR, left ventricular diameter (LVD), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), left atrial volume index (LAVI), left ventricular end-diastolic volume (LVEDV), serum NT-ProBNP, maximum early ventricular filling velocity/early diastolic velocity of the mitral annulus (E/Ea) ratio, and aortic regurgitation (AR) and lower levels of left ventricular ejection fraction (LVEF), flow propagation velocity (VP), and systolic/diastolic (S/D) ratio versus healthy subjects (all at P < 0.05).

Conclusion

The combined detection of echocardiography and serum NT-ProBNP yields a high clinical value in the diagnosis of DHF deficiency, as it can accurately evaluate the patient's left heart morphology and diastolic function, so it is worthy of clinical promotion and application.

BNP/NT-proBNP in pulmonary arterial hypertension: time for point-of-care testing?

Despite the advent of new therapies and improved outcomes in patients with pulmonary arterial hypertension (PAH), it remains a life-shortening disease and the time to diagnosis remains unchanged. Strategies to improve outcomes are therefore currently focused on earlier diagnosis and a treatment approach aimed at moving patients with PAH into a category of low-risk of 1-year mortality. B-type natriuretic peptide (BNP; or brain natriuretic peptide) and N-terminal prohormone of BNP (NT-proBNP) are released from cardiac myocytes in response to mechanical load and wall stress. Elevated levels of BNP and NT-proBNP are incorporated into several PAH risk stratification tools and screening algorithms to aid diagnosis of systemic sclerosis. We have undertaken a systematic review of the literature with respect to the use of BNP and NT-proBNP in PAH and the use of these biomarkers in the diagnosis and risk stratification of PAH, their relation to pulmonary haemodynamics and the potential for point-of-care testing to improve diagnosis and prognosis.

An evidence-based strategy to screen for pulmonary arterial hypertension in systemic sclerosis

BACKGROUND

Clinical practice guidelines recommend screening all systemic sclerosis (SSc) patients for pulmonary arterial hypertension (PAH) with yearly echocardiograms. There is a paucity of evidence to support these guidelines.

RESEARCH QUESTION

Can a prediction model identify SSc patients with a very low probability of PAH and therefore not requiring annual screening echocardiogram?

STUDY DESIGN AND METHODS

We performed a case-control study of 925 unselected SSc subjects nested in a multi-centered, longitudinal cohort. The probability of PAH for each subject was calculated using the results of multivariate logistic regression models. A cut-off was identified for the estimated probability of PAH below which no subject developed PAH (100% sensitivity).

RESULTS

Study subjects were predominantly female (87.5%), with mean (SD) age 58.6 (11.7) years and disease duration of 18.2 (12.2) years. Thirty-seven subjects developed PAH during 5407.97 person-years of observation (incidence rate 0.68 per 100 person-years). Shortness of breath (SOB), diffusing capacity for carbon monoxide (DLCO) and NT-proBNP were independent predictors of PAH. All SSc-PAH cases had a probability of PAH of >1.1%. Subjects below this cut-off, none of whom had PAH, accounted for 46.2% of the study population.

INTERPRETATION

A simple prediction model identified subjects at very low probability of PAH who could potentially forego annual screening echocardiogram. This represents almost half of SSc subjects in a general SSc population. This study, which is the first evidence-based study for the rational use of follow-up echocardiograms in an unselected SSc cohort, requires validation. The scoring system is freely available online at http://pahtool.ladydavis.ca.