Stress Doppler echocardiography ‘reliable’ for early PAH detection in systemic sclerosis

By Lucy Piper, Senior medwireNews Reporter

Researchers recommend performing echocardiography at rest and during exercise to screen for pulmonary arterial hypertension (PAH) in patients with systemic sclerosis (SSc).

They found that using Stress Doppler echocardiography (SDE) improved the sensitivity of PAH detection in SSc patients, aged an average of 58 years, to 95.2%, from 72.7% when echocardiography measurements were carried out at rest.

“SDE detected even patients with only mild manifest [pulmonary hypertension]/PAH-SSc at an early stage (mPAP [mean pulmonary arterial pressure] 25–30 mmHg), which was often overlook[ed] by echocardiography at rest only”, the team comments in Arthritis Research & Therapy.

Manifest PAH was confirmed by right heart catheterisation in 22 of 76 SSc patients, with further work-up confirming concomitant left heart disease in four patients, lung disease in three and SSc-associated PAH in 15. PAH was in the early stages, with a mean mPAP of 33 mmHg.

At rest, echocardiography diagnosed manifest PAH with a sensitivity of 72.7% and a specificity of 88.2%, using a pulmonary arterial systolic pressure threshold of above 40 mmHg.

But the researchers note that detection sensitivity increased to 95.2% with the use of SDE at a workload of 25 Watt and a cut-off pulmonary arterial systolic pressure value of above 45 mmHg. They also note that for binary classification of PAH diagnosis pulmonary arterial systolic pressure at 25 Watt was the only independent predictor.

The findings equate to five patients with PAH being missed when echocardiography was carried out at rest, compared with just one using SDE.

Researcher Ekkehard Grünig (University Hospital Heidelberg, Germany) and colleagues found that, although sensitivity for PAH improved with the use of SDE, specificity decreased from 88.2% to 84.9%, mainly due to concomitant cardiovascular diseases.

The team concludes that “SDE can be a reliable noninvasive screening method for early manifest PAH in SSc, if the assessment is standardized.”

They add: “These are first data, indicating that an early treatment with [pulmonary hypertension]-targeted therapy might attenuate [the pulmonary arterial systolic pressure] increase in patients with borderline [pulmonary hypertension] in SSc.”

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