Objective
Early detection of pulmonary arterial hypertension (PAH) is crucial to improve patient outcomes. The aim of this study was to compare the positive predictive value (PPV) between the echocardiography-derived tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (TAPSE/sPAP) ratio and the DETECT algorithm for PAH screening in a cohort of systemic sclerosis (SSc) patients.
Methods
51 SSc patients were screened for PAH using DETECT algorithm and echocardiography.
Results
Echocardiography was recommended by the DETECT algorithm step 1 in 34 patients (66.7%). Right heart catheterization (RHC) was recommended by the DETECT algorithm step 2 in 16 patients (31.4%). PAH was confirmed by RHC in 5 patients. DETECT algorithm positive predictive value (PPV) was 31.3%.TAPSE/sPAP ratio was higher in SSc patients not referred for RHC than in SSc patients referred for RHC according to DETECT algorithm step 2 [0.83 (0.35-1.40) mm/mmHg vs 0.74 (0.12-1.09) mm/mmHg, p < 0.05]. Using a cut-off of 0.60 mm/mmHg, 8 (15.7%) SSc patients had a TAPSE/sPAP ratio ≤0.60 mm/mmHg. PAH was confirmed by RHC in 5 patients. PPV of TAPSE/sPAP was 62.5%.
In multiple regression analysis, TAPSE/sPAP was associated with age (β coefficient = -0.348 [95% CI, -0.011 to -0.003]; p < 0.01), DETECT algorithm step 1 (β coefficient = 1.023 [95% CI, 0.006-0.024]; p < 0.01) and DETECT algorithm step 2 (β coefficient = -1.758 [95% CI, -0.059 to -0.021]; p < 0.0001).
Conclusion
In SSc patients with a DETECT algorithm step 2 total score >35 the TAPSE/sPAP ratio can be used to further select patients requiring RHC to confirm PAH diagnosis.
Introduction
Aims of study were to evaluate the prevalence of metabolic syndrome (MetS) in systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) patients and to evaluate serum level of adipokines in SLE and SSc patients with and without MetS.
Methods
Fifty SLE patients and 85 SSc patients were enrolled. The diagnosis of MetS was made according to the criteria of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III. Clinical assessment and serum levels of adiponectin and resistin were evaluate in SLE and SSc patients.
Results
Prevalence of MetS was significantly (p<0.0001) higher in SLE patients than SSc patients (36% vs 10.6%). Median values of resistin were significantly (p<0.001) higher in SLE patients with MetS than SLE patients without MetS [4.01 ng/mL (2.7–4.5) vs 1.92 ng/mL (1.2–3)]. Median values of adiponectin were significantly (p<0.05) lower in SLE patients with MetS than SLE patients without MetS [5.64 ng/mL (4.96–8) vs 8.38 ng/mL (6.54–11.01)]. Systemic Lupus Erythematosus Activity Index [8 (6–12) vs 10 (6–13), p<0.01] and Systemic Damage Index [2 (1–3) vs 2 (0–3), p<0.001] were significantly higher in MetS patients than in patients without MetS.
In SSc, the median value of disease severity scale was significantly higher (p<0.05) in MetS patients than in patients without MetS [7 (5–7) vs 5 (3–6)].
Conclusion
Prevalence of MetS is higher in SLE patients. In SLE patients, MetS showed an association with adipokine levels and inflammation/activity disease scores. In SSc patients, MetS was associated with severity of disease.
Key Points• Prevalence of metabolic syndrome is higher in SLE patients than SSc patients.• Resistin is higher in SLE patients with metabolic syndrome.• Adineponectin is lower in SLE patients with metabolic syndrome.• Disease severity scale is higher in SSc patients with metabolic syndrome.
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