Can a New Scoring System Improve Prediction of Pulmonary Hypertension in Newly Recognised Interstitial Lung Diseases?

Abstract

Introduction Pulmonary hypertension (PH) is a well-recognised complication of interstitial lung diseases (ILD), which worsens prognosis and impairs exercise capacity. Echocardiography is the most widely used, non-invasive method for PH assessment. The aim of our study was to identify the factors predictive for echocardiographic signs of PH in newly recognised ILD patients. Methods Ninety-three consecutive patients (28F/65M) with different ILD were prospectively evaluated from January 2009 to March 2014. Pulmonary function testing, 6-min walk distance (6MWD), initial and sixth minute room air oxygen saturation, NT-proBNP and echocardiography were assessed in each patient. Echocardiographic PH probability was determined according to the 2009 ESC/ERS guidelines. Results In 41 patients (Group B) increased PH possibility has been diagnosed on echocardiography, in 52 patients (Group A)-low PH probability. Most pronounced differences (p ≤ 0.0005) between groups B and A concerned: age, 6MWD, room air oxygen saturation at 6 min, DLCO and TLC/DLCO index (57.6 vs 43.8 years; 478 vs 583 m; 89.1% vs 93.4%; 54.8% predicted vs 70.5% predicted and 1.86 vs 1.44; respectively). Univariate analysis showed four-fold increased probability of PH when TLC/DLCO exceeded 1.67. A scoring system incorporating age, TLC/DLCO index, 6MWD and room air oxygen saturation at 6 min provided high diagnostic utility, AUC 0.867 (95% CI 0.792-0.867). Conclusion ILD patients with TLC/DLCO index > 1.67 have a high likelihood of PH and should undergo further evaluation. The composite model of PH prediction, including age, 6-min walk test and TLC/DLCO was highly specific for recognition of PH on echocardiography.

The Role of Pulmonary Function Test for Pulmonary Arterial Hypertension in Patients with Connective Tissue Disease

“…In addition to the factors of enlarged pulmonary vessels, the subsequent enlargement of the atria and ventricles may lead to the displacement of lung tissue within the thoracic cavity and affect the lung volume [ 32 ]. Most studies show that FEV1/FVC is normal in group I of PH [ 33 ]. This study showed that 95% of patients with CTD-PAH had an FEV1/FVC above 70%.…”

PH-ILD: Identification, Evaluation, and Monitoring: A Diagnostic View From Both Sides

“…In particular, multivariable analysis has generally led to the verification of this observation and to multiple algorithms incorporating a selected set of measurements (BNP, DLCO, echocardiography), 55 (Ratio of FVC/DLCO, PAA, RVSP) 56 (TLC/DLCO index, age, 6MWD, room air oxygen saturation at 6MW). 57 In absence of established research, a combination of these methods could be used to lead clinicians from routine history, examinations, and laboratory findings to a primary workup for PH with echocardiography, 6MWD measurements, and BNP/NT-proBNP, with a low threshold for RHC in the right clinical setting. (See Table)…”

A Nomogram for Predicting the Risk of Pulmonary Hypertension for Patients with Chronic Obstructive Pulmonary Disease

“…However, it is expensive, invasive, and associated with several complications, 8 Echocardiography is the most widely used and recommended non-invasive method for assessing PH. 9 Compared to RHC, echocardiography has been shown to be a reliable method in several studies. 10 , 11 In the 2015 European Society of Cardiology (ESC)/European Respiratory Society (ERS) Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension, echocardiography is the preferred non-invasive test for PH screening and follow-up; the guidelines also recommend that it should be used to screen for PH in patients whose clinical data suggest an increased risk of PH.…”