IJCA-17992; No of Pages 1 International Journal of Cardiology xxx (2014) xxx
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
The source of BNP in rheumatoid arthritis Jacob George a,⁎, F. Khan b, A.D. Struthers a a b
Centre for Cardiovascular & Lung Biology, Division of Medical Sciences, Mailbox 2, Ninewells Hospital & Medical School, Dundee DD1 9SY, UK Institute of Cardiovascular Research, Vascular & Inflammatory Diseases Research Unit, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
a r t i c l e
i n f o
Article history: Received 31 March 2014 Accepted 4 April 2014 Available online xxxx Keywords: Rheumatoid arthritis Brain natriuretic peptide Inflammation Left ventricular hypertrophy
pulmonary fibrosis. There was also no statistically significant difference in the degree of LVH between the RA and healthy cohorts as demonstrated by Fig. 1 in the article. We were not able to publish all data due to the word/ figure limit for letters. From the MONICA study, we know that sensitivity and specificity for the detection of diastolic dysfunction by BNP was poor and a normal BNP test virtually excluded the presence of diastolic dysfunction and concomitant LVH [3]. We accept that it is possible that elevated RVSP may contribute towards BNP levels in RA patients. However, the very fact that there was no difference in BNP levels between the two cohorts would signal, that PASP was not significantly raised in our RA cohort.
References We thank Dr Ozturk and colleagues for raising the issue of B-type natriuretic peptide (BNP) and high pulmonary artery systolic pressure (PASP) in patients with rheumatoid arthritis (RA) [1]. As they indicate, the role and source of BNP in patients with RA is still debated with conflicting results. Our study [2] was not designed to determine all possible causes of BNP in patient with RA. For example, we did not look for evidence of myocardial ischemia either. None of our patients had a diagnosis of Chronic Obstructive Airways disease or have known
[1] Cengiz OZTURK SB, Sait DEMIRKOL, Ahmet OZTURK, Turgay CELIK, Atila IYISOY. High BNP levels in rheumatoid arthritis may be related with right ventricular functions. Int J Cardiol 2014. [2] George J, Mackle G, Manoharan A, Khan F, Struthers AD. High BNP levels in rheumatoid arthritis are related to inflammation but not to left ventricular abnormalities: a prospective case–control study. Int J Cardiol 2014;172:e116–8. [3] Lukowicz TV, Fischer M, Hense HW, et al. BNP as a marker of diastolic dysfunction in the general population: importance of left ventricular hypertrophy. Eur J Heart Fail 2005;7:525–31.
⁎ Corresponding author at: Division of Medicine and Therapeutics, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. Tel.: +44 1382 383204; fax: +44 1382 644972. E-mail address: [email protected] (J. George).
http://dx.doi.org/10.1016/j.ijcard.2014.04.091 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved.
Please cite this article as: George J, et al, The source of BNP in rheumatoid arthritis, Int J Cardiol (2014), http://dx.doi.org/10.1016/ j.ijcard.2014.04.091
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
The source of BNP in rheumatoid arthritis Jacob George a,⁎, F. Khan b, A.D. Struthers a a b
Centre for Cardiovascular & Lung Biology, Division of Medical Sciences, Mailbox 2, Ninewells Hospital & Medical School, Dundee DD1 9SY, UK Institute of Cardiovascular Research, Vascular & Inflammatory Diseases Research Unit, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
a r t i c l e
i n f o
Article history: Received 31 March 2014 Accepted 4 April 2014 Available online xxxx Keywords: Rheumatoid arthritis Brain natriuretic peptide Inflammation Left ventricular hypertrophy
pulmonary fibrosis. There was also no statistically significant difference in the degree of LVH between the RA and healthy cohorts as demonstrated by Fig. 1 in the article. We were not able to publish all data due to the word/ figure limit for letters. From the MONICA study, we know that sensitivity and specificity for the detection of diastolic dysfunction by BNP was poor and a normal BNP test virtually excluded the presence of diastolic dysfunction and concomitant LVH [3]. We accept that it is possible that elevated RVSP may contribute towards BNP levels in RA patients. However, the very fact that there was no difference in BNP levels between the two cohorts would signal, that PASP was not significantly raised in our RA cohort.
References We thank Dr Ozturk and colleagues for raising the issue of B-type natriuretic peptide (BNP) and high pulmonary artery systolic pressure (PASP) in patients with rheumatoid arthritis (RA) [1]. As they indicate, the role and source of BNP in patients with RA is still debated with conflicting results. Our study [2] was not designed to determine all possible causes of BNP in patient with RA. For example, we did not look for evidence of myocardial ischemia either. None of our patients had a diagnosis of Chronic Obstructive Airways disease or have known
[1] Cengiz OZTURK SB, Sait DEMIRKOL, Ahmet OZTURK, Turgay CELIK, Atila IYISOY. High BNP levels in rheumatoid arthritis may be related with right ventricular functions. Int J Cardiol 2014. [2] George J, Mackle G, Manoharan A, Khan F, Struthers AD. High BNP levels in rheumatoid arthritis are related to inflammation but not to left ventricular abnormalities: a prospective case–control study. Int J Cardiol 2014;172:e116–8. [3] Lukowicz TV, Fischer M, Hense HW, et al. BNP as a marker of diastolic dysfunction in the general population: importance of left ventricular hypertrophy. Eur J Heart Fail 2005;7:525–31.
⁎ Corresponding author at: Division of Medicine and Therapeutics, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. Tel.: +44 1382 383204; fax: +44 1382 644972. E-mail address: [email protected] (J. George).
http://dx.doi.org/10.1016/j.ijcard.2014.04.091 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved.
Please cite this article as: George J, et al, The source of BNP in rheumatoid arthritis, Int J Cardiol (2014), http://dx.doi.org/10.1016/ j.ijcard.2014.04.091
