Comparison of Doppler echocardiography and right heart catheterization to assess pulmonary hypertension in systemic sclerosis

Abstract

Pulmonary hypertension (PHT) is an important complication of systemic sclerosis (SSc). Echocardiography can be used to detect PHT and, with Doppler echocardiography, the pulmonary arterial systolic pressure (PASP) can often be estimated. We have undertaken a study to compare echocardiographic assessment with right heart catheterization (RHC) in 33 SSc patients in whom clinical assessment [including ECG, chest X-ray, lung function tests and high-resolution computed tomography (HRCT) had raised strong suspicion of PHT. The mean (S.D.) interval between echocardiography and RHC was 1.8 (2.3) months. Twenty-one patients (64%) had PHT (PASP > or = 30 mmHg) on RHC, and echocardiography correctly identified 19 of these (sensitivity 90%). Of the 12 patients without PHT on RHC, nine were correctly identified by echocardiography (specificity 75%). The five incorrectly classified patients all had PASP in the borderline normal/abnormal range. The presence of tricuspid regurgitation allowed Doppler measurement of PASP in 20 patients (61%) and this correlated significantly with RHC values (r = 0.83, P < 0.001). We conclude that echocardiography is a reliable method for detecting PHT and it may be particularly useful for the early detection and monitoring of this potentially fatal complication in SSc.

Echocardiography as an Outcome Measure in Scleroderma-related Pulmonary Arterial Hypertension: A Systematic Literature Analysis by the EPOSS Group

“…Denton et al looked at a broad range of PAH/PH patients [34]. The range of PAP by RHC in the 6 patients with PAH/PH and no tricuspid regurgitation was similar to that seen in the 15 patients with PAH/PH in whom echoDoppler measurement revealed increased PAP (34-109 mmHg), indicating that even in patients with moderate/severe PAH/PH, tricuspid regurgitation might not be present.…”

“…Sensitivity and specificity depended strongly on the definition of PAH/PH by echo and the population of SSc patients [1,12,34,41]. The specificity of echo increased with the higher PASP thresholds, reaching 97% for PASP/tricuspid gradient ≥ 45 mmHg.…”

Evaluation and Management of the Patient with Pulmonary Arterial Hypertension

“…Echocardiography also provides information about the cause and consequences of pulmonary hypertension. Studies in patients with PAH (22)(23)(24)(25) have reported good correlations between Doppler-derived estimates of pulmonary arterial systolic pressure and direct measurements obtained by right-heart catheterization. Echocardiography also provides direct evidence about left ventricular systolic and diastolic function, as well as valvular function and morphologic characteristics that can give clues to causes of pulmonary hypertension due to elevated pulmonary venous pressures.…”

Avaliação da prevalência de hipertensão pulmonar na esclerose sistêmica

“…De acordo com este Consenso, somente valores de PSAP ≥ 40mmHg deveriam ser considerados para diagnóstico de HP pelo ECO (27) . Com a preocupação de diagnosticar precocemente o dano vascular pulmonar na ES, em vista da sua gravidade, o valor de PSAP ≥ 30 mmHg ao ECO tem sido utilizado por alguns autores, destacando-se o estudo de Denton et al (5) . No entanto, a crítica que se faz quanto à utilização deste ponto de corte é que este poderia implicar numa superestimativa dos casos de HP relacionados à ES.…”

“…Geralmente, os sinais e sintomas relacionados à HP na ES são insidiosos, principalmente nas fases iniciais desta complicação, e até um terço dos casos podem ser assintomáticos (1)(2)(3) . O ecodopplercardiograma bidimensional transtorácico é um exame útil para a medida não invasiva da pressão em artéria pulmonar, com sensibilidade de 90% e especificidade de 75% para o diagnóstico de HP na ES, através de medidas indiretas pelo jato de regurgitação tricúspide, considerando valores anormais para pressão sistólica de artéria pulmonar (PSAP) ≥ 30 mmHg (5) .…”