Combined peripheral and central ultrasound for the diagnosis of PAH‐SSc patients

• Published in: Echocardiography (Mount Kisco, N.Y.) N.Y.), 2024-06, Vol.41 (6), p.e15853-n/a
• Main Authors: Correale, Michele, Rotondo, Cinzia, Bevere, Ester Maria Lucia, Tricarico, Lucia, Rella, Valeria, Villani, Deborah, Granato, Mattia, Migliozzi, Celeste, Cantatore, Francesco Paolo, Brunetti, Natale Daniele, Corrado, Addolorata
• Format: Article
• Language: English
• Subjects: Adult; echocardiography; Echocardiography - methods; eco‐color Doppler; Female; flow‐mediated dilation; Humans; Hypertension, Pulmonary - complications; Hypertension, Pulmonary - diagnostic imaging; Hypertension, Pulmonary - physiopathology; Male; Middle Aged; pulmonary arterial hypertension; pulmonary hypertension; right heart function; Scleroderma, Systemic - complications; Scleroderma, Systemic - physiopathology
• ISSN: 0742-2822; 1540-8175
• DOI: 10.1111/echo.15853

Background Systemic Sclerosis (SSc), an intricate autoimmune disease causing tissue fibrosis, introduces cardiovascular complexities, notably pulmonary hypertension (PH), affecting both survival and quality of life. This study centers on evaluating echocardiographic parameters and endothelial function using flow‐mediated dilatation (FMD) in SSc patients, aiming to differentiate those with and without pulmonary arterial hypertension (PAH). The emphasis lies in early detection, given the heightened vulnerability of the right ventricle (RV) in the presence of PH. Methods Fifty‐nine SSc patients and 48 healthy subjects participated, undergoing clinical examinations, echocardiography, FMD assessments, blood analyses, and right heart catheterization (RHC) according to the ESC/ERS guidelines for diagnosis and treatment of PH. Results SSc‐PAH patients displayed lower FMD, higher frequency of TAPSE  18 cm2, act RVOT  280 cm/s compared to those without PAH and healthy controls. Resting resistivity index (RI) was higher in SSc patients, with no significant difference between those with and without PAH. Lower FMD% serves as a predictive marker for adverse cardiovascular outcomes in both SSc and SSc‐PAH patients. Stratification by TRV levels and PAH presence reveals notable FMD% variations, emphasizing its potential utility. Conclusions Early identification of endothelial dysfunction and impaired RV echocardiographic parameters, such as TAPSE and TRV, could aid in predicting right ventricular dysfunction and PAH in SSc patients. A careful evaluation of echocardiographic parameters, in particular TAPSE and TRV, and the assessment of the severity of endothelial dysfunction using the FMD could help clinicians to identify a particular subset of patients with a high risk of right ventricular dysfunction and PAH.