Simone Frea, M.D., Division of Cardiology, Cardiovascular and Thoracic Department, AOU S. Giovanni Battista “Molinette” di Torino, Torino, Italy. Fax: +390116336015; E-mail: [email protected]

Disclosure: None.

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Abstract

Objectives: Evaluate echocardiographic predictors of pulmonary artery hypertension (PAH) in a prospective cohort of patients with systemic sclerosis (SSc). Methods: 38 patients with SSc who did not have PAH and significant left heart disease, with peak tricuspid regurgitant velocity (TRV) ≤ 2.8 m/sec and systolic pulmonary artery pressure (sPAP) < 40 mmHg on echo Doppler were enrolled. Patients underwent: clinical assessment, NT-proBNP, and DLco measurements. Echo Doppler evaluation included right ventricular (RV) dimensions, tricuspid annular plan systolic excursion, fractional area change, tricuspid DTI systolic velocity, Tei index, pulmonary flow acceleration time (AcT), ratio of TRV to RV outflow tract time–velocity integral (TVI) and a parameter of disturbed RV ejection (TRV/AcT). After a planned 12-month follow-up we evaluated the predictive value of these parameters for the development of PAH, as demonstrated by right heart catheterization (RHC). Criteria for RHC were TRV ≥ 3 m/sec or sPAP ≥ 40 mmHg. Results: Four patients developed PAH. Only TRV/TVI and TRV/AcT ratios significantly predicted PAH development (TRV/TVI ratio ≥ 0.16 [predefined and ROC confirmed]: OR 99, CI 95%: 4.865–2015, P = 0.004; TRV/AcT ratio ≥ 0.022 [predefined and ROC confirmed]: OR 12.68, CI 95% 1.163–379.3, P = 0.036). Both parameters showed a good diagnostic power (TRV/TVI ratio: ROC area 79%, sensitivity 75%, specificity 97% and diagnostic accuracy 94.74% for cutoff value of 0.16; TRV/AcT ratio: ROC area 75%, sensitivity 75%, specificity 71% and diagnostic accuracy 72% for cutoff value of 0.022). Conclusions: This prospective study identified increased values of the two ratios TRV/TVI and TRV/AcT as predictors of PAH in SSc. (Echocardiography 2011;28:860-869)

References

1 Maddison PJ, Stephens C, Briggs D: Connective tissue disease and autoantibodies in the kindreds for 63 patients with systemic sclerosis. Medicine (Baltimore) 1993; 72: 103–112.
10.1097/00005792-199303000-00004
CAS PubMed Web of Science® Google Scholar
2 Masi AT, D’ Angelo WA: Epidemiology of fatal systemic sclerosis (diffuse scleroderma): A 15-year survey in Baltimore. Ann Intern Med 1967; 66: 870–883.
10.7326/0003-4819-66-5-870
CAS PubMed Web of Science® Google Scholar
3 Hachulla E, Gressin V, Guillevin L: L’Hypertension arterielle pulmonaire associée a la sclerodermie systemique: Proposition d’ un algorithme echocardiographique de dépistage pour un diagnostic précoce (ItinérAIR-Sclérodermie). Rev Méd Interne. 2004; 25: 340–347.
10.1016/j.revmed.2004.01.019
CAS PubMed Web of Science® Google Scholar
4 Hachulla E, Launay D, Yaici A, et al: French PAH-SSc Network. Primary arterial hypertension associated with systemic sclerosis in patients with functional class II dyspnoea: Mild symptoms but severe outcome. Rheumatology 2010; 49(5): 940–944.
10.1093/rheumatology/kep449
PubMed Web of Science® Google Scholar
5 Koh ET, Lee P, Gladman DD, et al: Pulmonary hypertension in systemic sclerosis: An analysis of 17 patients. Br Rheumatol 1996; 35: 989–993.
10.1093/rheumatology/35.10.989
CAS PubMed Web of Science® Google Scholar
6 MacGregor AJ, Canavan R, Knight C, et al: Pulmonary hypertension in systemic sclerosis: Risk factors for progression and consequences for survival. Rheumatology 2001, 40: 453–459.
10.1093/rheumatology/40.4.453
CAS PubMed Web of Science® Google Scholar
7 Abbas AE, Fortuin FD, Schiller NB, et al: A simple method for noninvasive estimation of pulmonary vascular resistance. J Am Coll Cardiol 2003; 41: 1021–1027.
10.1016/S0735-1097(02)02973-X
PubMed Web of Science® Google Scholar
8 Rajagopalan N, Simon MA, Suffoletto MS, et al: Noninvasive estimation of pulmonary vascular resistance in pulmonary hypertension. Echocardiography 2009; 26(5): 289–294.
10.1111/j.1540-8175.2008.00837.x
Web of Science® Google Scholar
9 Naeije R, Torbicki A: More on the noninvasive diagnosis of pulmonary hypertension: Doppler echocardiography revisited. Eur Respir J 1995; 8: 1445–1449.
10.1183/09031936.95.08091445
CAS PubMed Web of Science® Google Scholar
10 Kitabatake A, Inoue M, Asao M, et al: Noninvasive evaluation of pulmonary hypertension by a pulsed Doppler technique. Circ 1983; 68: 302–309.
10.1161/01.CIR.68.2.302
CAS PubMed Web of Science® Google Scholar
11 Dabestani A, Mahan G, Gardin JM, et al: Evaluation of pulmonary artery pressure and resistance by pulsed Doppler echocardiography. Am J Cardiol 1987; 59: 662–668.
10.1016/0002-9149(87)91189-1
CAS PubMed Web of Science® Google Scholar
12 Lanzarini L, Fontana A, Campana C, Klersy C: Two simple echo-Doppler measurements can accurately identify pulmonary hypertension in the large majority of patients with chronic heart failure. J Heart Lung Transpl 2005; 24: 745–754.
10.1016/j.healun.2004.03.026
PubMed Web of Science® Google Scholar
13 Huez S, Roufosse F, Vachiéry JL, et al: Isolated right ventricular dysfunction in systemic sclerosis: Latent pulmonary hypertension?. Eur Respir J 2007 Nov; 30(5): 928–936.
10.1183/09031936.00025607
CAS PubMed Web of Science® Google Scholar
14 Kurzyna M, Torbicki A, Pruszczyk P, et al: Disturbed right ventricular ejection pattern as a new Doppler echocardiographic sign of acute pulmonary embolism. Am J Cardiol 2002 Sep 1; 90(5): 507–518.
10.1016/S0002-9149(02)02523-7
PubMed Web of Science® Google Scholar
15 Galiè N, Hoeper MM, Humbert M, et al: ESC Committee for Practice Guidelines (CPG). Guidelines for the diagnosis and treatment of pulmonary hypertension: The Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J 2009 Oct; 30(20): 2493–2537.
10.1093/eurheartj/ehp297
PubMed Web of Science® Google Scholar
16 Hoeper M, Oudiz R, Peacock A, et al: End-point and clinical trial designs in pulmonary arterial hypertension: Clinical and regulatory perspectives. J Am Coll Cardiol 2004; 43: S48–S55.
10.1016/j.jacc.2004.02.010
PubMed Web of Science® Google Scholar
17 Hancock EW, Deal BJ, Mirvis DM, et al: American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; American College of Cardiology Foundation; Heart Rhythm Society, AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: Part V: Electrocardiogram changes associated with cardiac chamber hypertrophy: A scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol 2009; 53(11): 992–1002.
10.1016/j.jacc.2008.12.015
PubMed Web of Science® Google Scholar
18 Al-Naamani K, Hijal T, Nguyen V, et al: Predictive values of the electrocardiogram in diagnosing pulmonary hypertension. Int J Cardiol 2008; 127 (2): 214–218.
10.1016/j.ijcard.2007.06.005
PubMed Web of Science® Google Scholar
19 Allanore Y, Borderie D, Avouac J, et al: High N-Terminal Pro-Brain Natriuretic Peptide Levels and Low Diffusing Capacity for Carbon Monoxide as Independent Predictors of the Occurrence of Precapillary Pulmonary Arterial Hypertension in Patients with Systemic Sclerosis. Arthritis Rheum 2008; 58(1): 284–291.
10.1002/art.23187
CAS PubMed Web of Science® Google Scholar
20 American Thoracic Society: ATS Statement: Guidelines for the Six-minute Walk Test. Am J Respir Crit Care Med 2002; 166: 111–117.
10.1164/ajrccm.166.1.at1102
PubMed Web of Science® Google Scholar
21 Villalba WO, Sampaio-Barros PD, et al: Six minute walk test for the evaluation of pulmonary disease severity in scleroderma patients. Chest 2007; 131(1): 217–222.
10.1378/chest.06-0630
PubMed Web of Science® Google Scholar
22 American Thoracic Society: Lung function testing: Selection of reference values and interpretrative strategies. Am Rev Respir Dis 1991; 144: 1202–1215.
10.1164/ajrccm/144.5.1202
PubMed Web of Science® Google Scholar
23 Pellegrino R, Viegi G, Brusasco V, et al: Interpretative strategies for lung function tests. Eur Respir J 2005; 26(5): 948–968.
10.1183/09031936.05.00035205
CAS PubMed Web of Science® Google Scholar
24 Warrick JH, Bhalla M, Schabel SI, et al: High resolution computed tomography in early scleroderma lung disease. J Rheumatol 1991; 18: 1520–1528.
CAS PubMed Web of Science® Google Scholar
25 Lai WW, Gauvreau K, Rivera ES, et al: Accuracy of guideline recommendations for two-dimensional quantification of the right ventricle by echocardiography. Int J Cardiovasc Imaging 2008; 24: 691–698.
10.1007/s10554-008-9314-4
PubMed Web of Science® Google Scholar
26 Lang RM, Bierig M, Devereux RB, et al: Recommendations for chamber quantification: A report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18: 1440–1463.
10.1046/j.1540-8167.2004.03625.x
PubMed Web of Science® Google Scholar
27 McLean AS, Ting I, Huang SJ, Wesley S: The use of the right ventricular diameter and tricuspid annular tissue Doppler velocity parameter to predict the presence of pulmonary hypertension. Eur J Echocardiogr 2007; 8: 128–136.
10.1016/j.euje.2006.02.005
PubMed Web of Science® Google Scholar
28 Kaul S, Tei C, Hopkins JM, Shah PM: Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J 1984; 107: 526–531.
10.1016/0002-8703(84)90095-4
CAS PubMed Web of Science® Google Scholar
29 Tamborini G, Pepi M, Galli CA, et al: Feasibility and accuracy of a routine echocardiographic assessment of right ventricular function. Int J Cardiol 2007; 115: 86–89.
10.1016/j.ijcard.2006.01.017
PubMed Web of Science® Google Scholar
30 Melek M, Esen O, Esen AM, et al: Tissue Doppler evaluation of tricuspid annulus for estimation of pulmonary artery pressure in patients with COPD. Lung 2006; 184: 121–131.
10.1007/s00408-005-2571-2
PubMed Web of Science® Google Scholar
31 Rajagopalan N, Simon MA, Suffoletto MS, et al: Noninvasive estimation of pulmonary vascular resistance in pulmonary hypertension. Echocardiography 2009; 26: 489–494.
10.1111/j.1540-8175.2008.00837.x
CAS PubMed Web of Science® Google Scholar
32 Vonk MC, Sander MH, Van Der Hoogen FH, et al: Right ventricle Tei index: A tool to increase the accuracy of non-invasive detection of pulmonary arterial hypertension in connective tissue diseases. Eur J Echocardiogr 2007; 8: 317–321.
10.1016/j.euje.2006.06.002
CAS PubMed Web of Science® Google Scholar
33 Steen V, Medsger TA Jr: Predictors of isolated pulmonary hypertension in patients with systemic sclerosis and limited cutaneous involvement. Arthritis Rheum 2003; 48: 516–522.
10.1002/art.10775
CAS PubMed Web of Science® Google Scholar
34 Andreassen AK, Wergeland R, Simonsen S, et al: N-terminal pro-B-type natriuretic peptide as an indicator of disease severity in a heterogeneous group of patients with chronic precapillary pulmonary hypertension. Am J Cardiol 2006; 98: 525–529.
10.1016/j.amjcard.2006.02.061
CAS PubMed Web of Science® Google Scholar
35 De Santis M, Bosello S, La Torre G, et al: Functional, radiological and biological markers of alveolitis and infections of the lower respiratory tract in patients with systemic sclerosis. Respir Res 2005; 6: 96–106.
10.1186/1465-9921-6-96
PubMed Web of Science® Google Scholar
36 Chow S, Pope JE, Mehta S: Lack of correlation of the health assessment questionnaire disability index with lung parameters in systemic sclerosis associated pulmonary arterial hypertension. Clin Exp Rheumatol. 2008; 26(6): 1012–1017.
CAS PubMed Web of Science® Google Scholar

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Volume28, Issue8

September 2011

Pages 860-869

Echo Doppler Predictors of Pulmonary Artery Hypertension in Patients with Systemic Sclerosis

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Echo Doppler Predictors of Pulmonary Artery Hypertension in Patients with Systemic Sclerosis

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