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European Heart Journal Advance Access originally published online on December 13, 2006
European Heart Journal 2007 28(1):141; doi:10.1093/eurheartj/ehl426
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

N-terminal brain natriuretic peptide in scleroderma-associated pulmonary arterial hypertension: reply

John Gerry Coghlan

Department of Cardiology
Royal Free Hospital
Pond Street
London NW3 2QG
UK
E-mail address: gerry.coghlan{at}royalfree.nhs.uk

Clive E. Handler

National Pulmonary Hypertension Service
Royal Free Hospital
Pond Street
London NW3 2QG
UK

We read with interest the comments of Mathai and Hassoun, and agree that caution is required in using an NTproBNP level of 395 pg/mL to discriminate between those with scleroderma-associated pulmonary arterial hypertension (SScPAH) and those without this complication. The purpose of the study was to evaluate this level that had been determined in our previous study. Given the consistency of our findings, we are now in the process of performing a much larger screening trial, to determine whether this threshold level is useful. The threshold level we identified (395 pg/mL) is substantially higher than that used in heart failure trials and is therefore less influenced by non-specific elevations seen with age and BMI, however, these issues will be addressed in the definitive study.

We have already evaluated the usefulness of clinical assessment in determining the prevalence of coronary disease in patients with scleroderma, and are therefore relatively confident that this is not a significant cause of non-specific elevations of NTproBNP in either population.1 We read with interest their experience in ILD-associated SscPAH. Our experience has been that although the response to therapy is less dramatic, the prognosis is not significantly different.2,3

We feel that the most important observation from this study is that 10-fold changes in NTproBNP during therapy are the strongest independent predictor of survival, and thus provides a potential rationale for goal-directed therapy.

References

  1. Akram MR, Handler CE, Williams M, Carulli MT, Andron M, Black CM, Denton CP, Coghlan JG. (2006) Angiographically proven coronary artery disease in scleroderma. Rheumatology (Oxford) 45:1395–1398.
  2. Mukerjee D, St George D, Coleiro B, Denton CP, Knight C, Davar J, Black CM, Coghlan JG. (2003) Prevalence and outcome in systemic sclerosis associated pulmonary arterial hypertension: application of a registry approach. Ann Rheum Dis 62:1088–1093.[Abstract/Free Full Text]
  3. Coghlan JG and Handler C. (2006) Connective tissue associated pulmonary arterial hypertension. Lupus 15:138–142.[Abstract/Free Full Text]

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This Article
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