Combination of echocardiography and pulmonary function tests could predict no complication of pulmonary hypertension during 5 years in patients with systemic sclerosis

• Published in: International journal of rheumatic diseases 2023-03, Vol.26 (3), p.493-500
• Main Authors: Yoneda, Katsuhiko, Takahashi, Soshi, Nakayama, Kazuhiko, Iwahashi, Masanori, Emoto, Noriaki, Kumagai, Shunichi
• Format: Article
• Language: English
• Subjects: Cardiac Catheterization - adverse effects; Echocardiography; Humans; Hypertension, Pulmonary - diagnosis; Lung; pulmonary function tests; pulmonary hypertension; Respiratory Function Tests - adverse effects; right heart catheterization; Scleroderma, Systemic - complications; screening; systemic sclerosis
• ISSN: 1756-1841; 1756-185X
• DOI: 10.1111/1756-185X.14576

Objective To determine whether complications of pulmonary hypertension (PH) can be predicted by noninvasive screening tests in systemic sclerosis (SSc). Methods Forty‐seven of 113 SSc patients underwent right heart catheterization (RHC) during 2011–2014. Clinical data, hemodynamic features, echocardiography, and pulmonary function tests had been followed up from the first RHC until 5 years later. Results At the first RHC, out of 44 patients, 8 were diagnosed with pre‐capillary PH (mean pulmonary arterial pressure [mPAP] > 20 mm Hg), and 36 patients were defined as no‐PH (mPAP ≤ 20 mm Hg). Three patients with >15 mm Hg of pulmonary artery wedge pressure were excluded. Receiver operating characteristic analyses for pre‐capillary PH using estimated systolic PAP (esPAP) revealed an area under the curve (AUC) of 0.736, with a sensitivity and specificity of 62.5% and 86.1%, respectively, at a cutoff level of 35.0 mm Hg. The predicted percentage diffusing lung capacity for carbon monoxide (DLCO%) revealed an AUC of 0.840, with a sensitivity and specificity of 85.7% and 80.0%, respectively, at a cutoff level of 70.0%. Six pre‐capillary PH patients, including one who died from PH 14 months after the first RHC, indicated exacerbations of mPAP or esPAP within 5 years. When esPAP  70% were met as the cutoff, none had been newly diagnosed with PH over 5 years. Conclusions The conventional screening tests may be useful for detecting pre‐capillary PH with SSc, and both esPAP  70% indicated a lower risk of developing PH for at least 5 years.