Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/103108
Type: Journal article
Title: The role of asymmetric dimethylarginine alone and in combination with N-terminal pro-B-type natriuretic peptide as a screening biomarker for systemic sclerosis-related pulmonary arterial hypertension: a case control study
Author: Thakkar, V.
Stevens, W.
Prior, D.
Rabusa, C.
Sahhar, J.
G Walker, J.
Roddy, J.
Lester, S.
Rischmueller, M.
Zochling, J.
Nash, P.
Gabbay, E.
Youssef, P.
Proudman, S.
Nikpour, M.
Citation: Clinical and Experimental Rheumatology, 2016; 34(5 (Suppl.100)):129-136
Publisher: Pacini editore
Issue Date: 2016
ISSN: 0392-856X
1593-098X
Statement of
Responsibility: 
V. Thakkar, W. Stevens, D. Prior, C. Rabusa, J. Sahhar, J. Walker, J. Roddy, S. Lester, M. Rischmueller, J. Zochling, P. Nash, E. Gabbay, P. Youssef, S. Proudman, M. Nikpour
Abstract: OBJECTIVES: Asymmetric dimethylarginine (ADMA) is a novel biomarker of endothelial cell dysfunction. In this proof of concept study, we sought to evaluate the role of ADMA as a screening biomarker for incident systemic sclerosis-related pulmonary arterial hypertension (SSc-PAH). METHODS: ADMA levels were measured using high performance liquid chromatography in 15 consecutive treatment-naive patients with newly-diagnosed SSc-PAH and compared with 30 SSc-controls without PAH. Logistic regression models were used to evaluate the independent association of ADMA with PAH. The optimal cut-point of ADMA for SSc-PAH screening was determined. NT-proBNP levels were previously measured in the same patients and the optimal cut-point of NT-proBNP of ≥210ng/mL was coupled with the optimal cut-point of ADMA to create a screening model that combined the two biomarkers. RESULTS: The PAH group had significantly higher mean ADMA levels than the control group (0.76±0.14 μM versus 0.59±0.07 μM; p<0.0001). ADMA levels remained significantly associated with PAH after the adjustment for specific disease characteristics, cardiovascular risk factors and other SSc-related vascular complications (all p<0.01). An ADMA level ≥0.7 μM had a sensitivity of 86.7%, specificity of 90.0% and AUC of 0.86 for diagnosing PAH. A screening model that combined an NT-proBNP ≥210ng/mL and/ or ADMA ≥0.7 ng/mL resulted in a sensitivity of 100% and specificity of 90% for the detection of SSc-PAH. CONCLUSIONS: In this small study, use of ADMA in combination with NT-proBNP produced excellent sensitivity and specificity for the non-invasive identification of SSc-PAH. The role of ADMA as a screening biomarker for SSc-PAH merits further evaluation.
Keywords: Pulmonary Artery; Humans; Hypertension, Pulmonary; Scleroderma, Systemic; Natriuretic Peptide, Brain; Arginine; Peptide Fragments; Prognosis; Chromatography, High Pressure Liquid; Area Under Curve; Logistic Models; Risk Factors; Case-Control Studies; Predictive Value of Tests; ROC Curve; Adult; Middle Aged; Australia; Female; Male; Arterial Pressure; Biomarkers
Description: Published: 13/10/2016. CER8524
Rights: Copyright status unknown
RMID: 0030048866
Published version: http://www.clinexprheumatol.org/abstract.asp?a=9406
Appears in Collections:Medicine publications

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