Role of BNP and echo measurement for pulmonary hypertension recognition in patients with interstitial lung disease: An algorithm application model

Abstract Background: This study evaluated the rote of echocardiography and BNP in patients with interstitial lung disease (ILD), to identify those with PH and RV dysfunction. The aims of this study were: 1-to evaluate the accuracy of an algorithm including BNP, DLCO and echocardiographic measurements to identify PH and RV dysfunction; 2- to evaluate BNP and Echo values concordance in relation to right catheterization measurement. Methods: We analyzed 113 patients with diagnosis of ILD. Echo examination included: Pulmonary systolic, diastolic and mean Arterial Pressure (PAPs, PAPd, PAP mean), End-Diastolic and End-Systolic right ventricle diameters, Inferior Caval Vein diameter, and Tricuspid Annular Plane Systolic Excursion (TAPSE). Patients revealing increased PAPs at echocardiography underwent to catheterization. Results: Patients with PAPs > 40 mm Hg (37 patients), PAPmean >= 25 mm Hg (23 patients) and PAPd >= 20 mm Hg showed BNP increased (157 +/- 96 vs 16 +/- 14 pg/ml p = 0.004; 201 +/- 120 vs 28 +/- 17 pg/mL; 124 +/- 88 vs 23 +/- 18 pg/ml p <0.001) as patients with TAPSE <= 16 mm (25 patients) (145 +/- 104 vs 26 +/- 21 pg/ml p <0.001). In catheterized patients (37 patients) BNP was increased in patients with invasive PAPs > 40 mm Hg (165 +/- 112 vs 29 +/- 14 pg/ml p <0.02), as well as in patients with Wedge pressure > 14 mm Hg (199 + 153 vs 54 + 39 pg/mL; p = 0.01). ROC Curve analysis showed that elevated values of BNP, PAPs, PAP mean are able to assess PH. On the other hand, lower values of DLCO (<40%) and TAPSE (<= 16 mm) detect PH. Logistic regression analysis of the previous parameters, confirmed their diagnostic role in PH detection. Conclusions: In patients with ILD, an algorithm including BNP, DLCO and echocardiography could be useful for non invasive screening of PH.