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Stress Doppler echocardiography for early detection of systemic sclerosis-associated pulmonary arterial hypertension

INTRODUCTION: In patients with systemic sclerosis (SSc), associated pulmonary arterial hypertension (SSc-APAH) is the leading cause of death. The objective of this prospective screening study was to analyse sensitivity and specificity of stress Doppler echocardiography (SDE) in detecting pulmonary h...

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Autores principales: Nagel, Christian, Henn, Philipp, Ehlken, Nicola, D’Andrea, Antonello, Blank, Norbert, Bossone, Eduardo, Böttger, Anke, Fiehn, Christoph, Fischer, Christine, Lorenz, Hanns-Martin, Stöckl, Frank, Grünig, Ekkehard, Egenlauf, Benjamin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504224/
https://www.ncbi.nlm.nih.gov/pubmed/26084934
http://dx.doi.org/10.1186/s13075-015-0673-7
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author Nagel, Christian
Henn, Philipp
Ehlken, Nicola
D’Andrea, Antonello
Blank, Norbert
Bossone, Eduardo
Böttger, Anke
Fiehn, Christoph
Fischer, Christine
Lorenz, Hanns-Martin
Stöckl, Frank
Grünig, Ekkehard
Egenlauf, Benjamin
author_facet Nagel, Christian
Henn, Philipp
Ehlken, Nicola
D’Andrea, Antonello
Blank, Norbert
Bossone, Eduardo
Böttger, Anke
Fiehn, Christoph
Fischer, Christine
Lorenz, Hanns-Martin
Stöckl, Frank
Grünig, Ekkehard
Egenlauf, Benjamin
author_sort Nagel, Christian
collection PubMed
description INTRODUCTION: In patients with systemic sclerosis (SSc), associated pulmonary arterial hypertension (SSc-APAH) is the leading cause of death. The objective of this prospective screening study was to analyse sensitivity and specificity of stress Doppler echocardiography (SDE) in detecting pulmonary hypertension (PH). METHODS: Pulmonary artery pressures and further parameters of PH were assessed by echocardiography and right heart catheterisation (RHC) at rest and during exercise in patients with SSc. Investigators of RHC were blinded to the results of non-invasive measurements. RESULTS: Of 76 patients with SSc (64 were female and mean age was 58±14 years), 22 (29 %) had manifest PH confirmed by RHC: four had concomitant left heart diseases, three had lung diseases, and 15 had SSc-APAH. Echocardiography at rest missed PH diagnosis in five of 22 patients with PH when a cutoff value for systolic pulmonary arterial pressure (PASP) was more than 40 mm Hg at rest. The sensitivity of echocardiography at rest was 72.7 % (95 % confidence interval (CI) 0.52–0.88), and specificity was 88.2 % (95 % CI 0.78–0.95). When a cutoff value for PASP was more than 45 mm Hg during low-dose exercise, SDE missed PH diagnosis in one of the 22 patients with PH and improved sensitivity to 95.2 % (95 % CI 0.81–1.0) but reduced specificity to 84.9 % (95 % CI 0.74–0.93). Reduction of specificity was partly due to concomitant left heart disease. CONCLUSIONS: The results of this prospective cross-sectional study using RHC as gold standard in all patients showed that SDE markedly improved sensitivity in detecting manifest PH to 95.2 % compared with 72.7 % using echocardiography at rest only. Thus, for PH screening in patients with SSc, echocardiography should be performed at rest and during exercise. TRIAL REGISTRATION: ClinicalTrials.gov NCT01387035. Registered 29 June 2011.
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spelling pubmed-45042242015-07-17 Stress Doppler echocardiography for early detection of systemic sclerosis-associated pulmonary arterial hypertension Nagel, Christian Henn, Philipp Ehlken, Nicola D’Andrea, Antonello Blank, Norbert Bossone, Eduardo Böttger, Anke Fiehn, Christoph Fischer, Christine Lorenz, Hanns-Martin Stöckl, Frank Grünig, Ekkehard Egenlauf, Benjamin Arthritis Res Ther Research Article INTRODUCTION: In patients with systemic sclerosis (SSc), associated pulmonary arterial hypertension (SSc-APAH) is the leading cause of death. The objective of this prospective screening study was to analyse sensitivity and specificity of stress Doppler echocardiography (SDE) in detecting pulmonary hypertension (PH). METHODS: Pulmonary artery pressures and further parameters of PH were assessed by echocardiography and right heart catheterisation (RHC) at rest and during exercise in patients with SSc. Investigators of RHC were blinded to the results of non-invasive measurements. RESULTS: Of 76 patients with SSc (64 were female and mean age was 58±14 years), 22 (29 %) had manifest PH confirmed by RHC: four had concomitant left heart diseases, three had lung diseases, and 15 had SSc-APAH. Echocardiography at rest missed PH diagnosis in five of 22 patients with PH when a cutoff value for systolic pulmonary arterial pressure (PASP) was more than 40 mm Hg at rest. The sensitivity of echocardiography at rest was 72.7 % (95 % confidence interval (CI) 0.52–0.88), and specificity was 88.2 % (95 % CI 0.78–0.95). When a cutoff value for PASP was more than 45 mm Hg during low-dose exercise, SDE missed PH diagnosis in one of the 22 patients with PH and improved sensitivity to 95.2 % (95 % CI 0.81–1.0) but reduced specificity to 84.9 % (95 % CI 0.74–0.93). Reduction of specificity was partly due to concomitant left heart disease. CONCLUSIONS: The results of this prospective cross-sectional study using RHC as gold standard in all patients showed that SDE markedly improved sensitivity in detecting manifest PH to 95.2 % compared with 72.7 % using echocardiography at rest only. Thus, for PH screening in patients with SSc, echocardiography should be performed at rest and during exercise. TRIAL REGISTRATION: ClinicalTrials.gov NCT01387035. Registered 29 June 2011. BioMed Central 2015-06-19 2015 /pmc/articles/PMC4504224/ /pubmed/26084934 http://dx.doi.org/10.1186/s13075-015-0673-7 Text en © Nagel et al. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Nagel, Christian
Henn, Philipp
Ehlken, Nicola
D’Andrea, Antonello
Blank, Norbert
Bossone, Eduardo
Böttger, Anke
Fiehn, Christoph
Fischer, Christine
Lorenz, Hanns-Martin
Stöckl, Frank
Grünig, Ekkehard
Egenlauf, Benjamin
Stress Doppler echocardiography for early detection of systemic sclerosis-associated pulmonary arterial hypertension
title Stress Doppler echocardiography for early detection of systemic sclerosis-associated pulmonary arterial hypertension
title_full Stress Doppler echocardiography for early detection of systemic sclerosis-associated pulmonary arterial hypertension
title_fullStr Stress Doppler echocardiography for early detection of systemic sclerosis-associated pulmonary arterial hypertension
title_full_unstemmed Stress Doppler echocardiography for early detection of systemic sclerosis-associated pulmonary arterial hypertension
title_short Stress Doppler echocardiography for early detection of systemic sclerosis-associated pulmonary arterial hypertension
title_sort stress doppler echocardiography for early detection of systemic sclerosis-associated pulmonary arterial hypertension
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504224/
https://www.ncbi.nlm.nih.gov/pubmed/26084934
http://dx.doi.org/10.1186/s13075-015-0673-7
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