Clinical Rheumatology

, Volume 29, Issue 9, pp 957–964 | Cite as

Left atrial volume and N-terminal pro-B type natriuretic peptide are associated with elevated pulmonary artery pressure in patients with systemic sclerosis

  • Theodoros DimitroulasEmail author
  • Georgios Giannakoulas
  • Klio Papadopoulou
  • Tilemahos Sfetsios
  • Haralambos Karvounis
  • Hariklia Dimitroula
  • Despina Parcharidou
  • Georgios Koliakos
  • Alexandros Garyfallos
  • Ioannis Styliadis
  • Loukas Settas
Original Article


Early detection of pulmonary hypertension (PH) in patients with systemic sclerosis (SSc) is essential as it leads to substantial morbidity and mortality irrespective of its etiology. The aim of our study was to determine whether noninvasive biochemical and/or echocardiographic indices can predict the presence of PH in these patients. We prospectively studied 66 patients (mean age of 57.7 ± 12.1 years, 63 women) with SSc without clinical manifestations of heart failure. All patients underwent standard and tissue Doppler echocardiography. Plasma N-terminal pro-B type natriuretic peptide (NT-proBNP) and asymmetric dimethylarginine (ADMA) levels were also measured. In 24 (36%) patients, the diagnosis of PH was established by echocardiography (systolic pulmonary artery pressure value ≥40 mmHg). Left atrial (LA) volume, NT-proBNP, ADMA, ratio of early transmitral filling velocity to early diastolic velocity of the mitral annulus (mitral E/E m), and right ventricular myocardial performance index (MPI) were univariate predictors of PH. In multivariate analysis, NT-proBNP, LA volume, and right ventricular MPI were independent predictors of PH in SSc patients. LA volume and NT-proBNP may be useful noninvasive markers for the prediction of elevated pulmonary artery pressure in patients with SSc. These parameters should be considered when assessing this population for risk stratification and for identification of patients demanding further investigation and institution of specific therapy for the disease at the time when it is most likely to be effective.


Left atrial volume N-terminal pro-brain natriuretic peptide Pulmonary hypertension Systemic sclerosis 



The authors would like to thank Mrs. Christina Befani for the excellent technical assistance.




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Copyright information

© Clinical Rheumatology 2010

Authors and Affiliations

  • Theodoros Dimitroulas
    • 1
    Email author
  • Georgios Giannakoulas
    • 2
  • Klio Papadopoulou
    • 2
  • Tilemahos Sfetsios
    • 1
  • Haralambos Karvounis
    • 2
  • Hariklia Dimitroula
    • 2
  • Despina Parcharidou
    • 2
  • Georgios Koliakos
    • 3
  • Alexandros Garyfallos
    • 4
  • Ioannis Styliadis
    • 2
  • Loukas Settas
    • 1
  1. 1.First Department of Internal MedicineAHEPA University HospitalThessalonikiGreece
  2. 2.First Department of CardiologyAHEPA University HospitalThessalonikiGreece
  3. 3.Department of BiochemistryAristotle University of ThessalonikiThessalonikiGreece
  4. 4.Fourth Department of Internal MedicineHippokration General HospitalThessalonikiGreece

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