Diffusing Capacity of the Lungs for Carbon Monoxide and Echocardiographic Parameters in Identifying Mild Pulmonary Hypertension in the EUSTAR Cohort of Patients With Systemic Sclerosis
Copyright policy )Diffusing Capacity of the Lungs for Carbon Monoxide and Echocardiographic Parameters in Identifying Mild Pulmonary Hypertension in the EUSTAR Cohort of Patients With Systemic Sclerosis
The 2022 European Society of Cardiology/European Respiratory Society guidelines define pulmonary hypertension (PH) as a resting mean pulmonary artery pressure (mPAP) > 20 mm Hg at right heart catheterization (RHC). Previously, patients with an mPAP between 21 and 24 mm Hg were classified in a "gray zone" of unclear clinical significance.What is the diagnostic performance of the main parameters used for PH screening in detecting patients with systemic sclerosis (SSc) with an mPAP of 21 to 24 mm Hg at RHC?Patients with SSc from the European Scleroderma Trials and Research (EUSTAR) database with available tricuspid annular plane systolic excursion (TAPSE), systolic PAP (sPAP), and mPAP data were included. Patients with mPAP 21 to 24 mm Hg and patients with mPAP ≤ 20 mm Hg were considered for the analysis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated.TAPSE/sPAP was lower in the group of patients with SSc with mPAP 21 to 24 mm Hg than in the non-PH group (0.58 [0.46-0.72] vs 0.69 [0.57-0.81] mm/mm Hg, respectively; P < .01). No difference was found in other parameters between the two groups. Diffusing capacity of the lungs for carbon monoxide < 80% of the predicted value had the highest sensitivity (88.9%) and NPV (80%), but the lowest specificity (18.2%) and PPV (30.8%) in detecting patients with SSc with mPAP 21 to 24 mm Hg. TAPSE/sPAP < 0.55 mm/mm Hg had the highest specificity (78.9%), PPV (50%), and accuracy (68.1%); its NPV was 75.4%, and its sensitivity was 45.1%.In this study, diffusing capacity of the lungs for carbon monoxide < 80% of the predicted value was the parameter with the highest sensitivity and NPV in detecting patients with SSc with mPAP 21 to 24 mm Hg. TAPSE/sPAP < 0.55 mm/mm Hg had the highest specificity, PPV, and accuracy and, therefore, can be a useful additional parameter to decrease the number of unnecessary RHCs.
- University of Lille France
- University of Padua Italy
- Radboud University Nijmegen Netherlands
- Universitätsklinikum Erlangen Germany
- Ghent University, VIB-UGent Center for Inflammation Research Belgium
Male, Cardiac Catheterization, TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::técnicas y procedimientos diagnósticos::diagnóstico por imagen::técnicas de imagen cardíaca::ecocardiografía, Hypertension, Pulmonary, Sensitivity and Specificity, CHEMICALS AND DRUGS::Inorganic Chemicals::Carbon Compounds, Inorganic::Carbon Monoxide, ENFERMEDADES::enfermedades respiratorias::enfermedades pulmonares::hipertensión pulmonar, TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::técnicas y procedimientos diagnósticos::técnicas diagnósticas respiratorias::pruebas de función respiratoria::intercambio gaseoso pulmonar::capacidad de difusión pulmonar, Predictive Value of Tests, DISEASES::Skin and Connective Tissue Diseases::Connective Tissue Diseases::Scleroderma, Systemic, Humans, Monòxid de carboni, Aged, Carbon Monoxide, Scleroderma, Systemic, Aparell respiratori - Proves funcionals, Middle Aged, Hipertensió pulmonar - Diagnòstic, [SDV] Life Sciences [q-bio], DISEASES::Respiratory Tract Diseases::Lung Diseases::Hypertension, Pulmonary, COMPUESTOS QUÍMICOS Y DROGAS::compuestos inorgánicos::compuestos inorgánicos del carbono::monóxido de carbono, Echocardiography, Rheumatology - Radboud University Medical Center, Esclerosi sistemàtica progressiva, ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Techniques, Respiratory System::Respiratory Function Tests::Pulmonary Gas Exchange::Pulmonary Diffusing Capacity, Pulmonary Diffusing Capacity, Female, ENFERMEDADES::enfermedades de la piel y tejido conjuntivo::enfermedades del tejido conjuntivo::esclerodermia sistémica, ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Imaging::Cardiac Imaging Techniques::Echocardiography, diffusing capacity of the lungs for carbon monoxide; pulmonary hypertension; screening; systemic sclerosis; tricuspid annular plane systolic excursion/systolic pulmonary arterial pressure, Ecocardiografia
Male, Cardiac Catheterization, TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::técnicas y procedimientos diagnósticos::diagnóstico por imagen::técnicas de imagen cardíaca::ecocardiografía, Hypertension, Pulmonary, Sensitivity and Specificity, CHEMICALS AND DRUGS::Inorganic Chemicals::Carbon Compounds, Inorganic::Carbon Monoxide, ENFERMEDADES::enfermedades respiratorias::enfermedades pulmonares::hipertensión pulmonar, TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::técnicas y procedimientos diagnósticos::técnicas diagnósticas respiratorias::pruebas de función respiratoria::intercambio gaseoso pulmonar::capacidad de difusión pulmonar, Predictive Value of Tests, DISEASES::Skin and Connective Tissue Diseases::Connective Tissue Diseases::Scleroderma, Systemic, Humans, Monòxid de carboni, Aged, Carbon Monoxide, Scleroderma, Systemic, Aparell respiratori - Proves funcionals, Middle Aged, Hipertensió pulmonar - Diagnòstic, [SDV] Life Sciences [q-bio], DISEASES::Respiratory Tract Diseases::Lung Diseases::Hypertension, Pulmonary, COMPUESTOS QUÍMICOS Y DROGAS::compuestos inorgánicos::compuestos inorgánicos del carbono::monóxido de carbono, Echocardiography, Rheumatology - Radboud University Medical Center, Esclerosi sistemàtica progressiva, ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Techniques, Respiratory System::Respiratory Function Tests::Pulmonary Gas Exchange::Pulmonary Diffusing Capacity, Pulmonary Diffusing Capacity, Female, ENFERMEDADES::enfermedades de la piel y tejido conjuntivo::enfermedades del tejido conjuntivo::esclerodermia sistémica, ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Imaging::Cardiac Imaging Techniques::Echocardiography, diffusing capacity of the lungs for carbon monoxide; pulmonary hypertension; screening; systemic sclerosis; tricuspid annular plane systolic excursion/systolic pulmonary arterial pressure, Ecocardiografia
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