Cardiac Catheterization versus Echocardiography for Monitoring Pulmonary Pressure: A Prospective Study in Patients with Connective Tissue Disease-Associated Pulmonary Arterial Hypertension

Abstract

Standard echocardiography is important for pulmonary arterial hypertension (PAH) screening in patients with connective tissue disease (CTD), but PAH diagnosis and monitoring require cardiac catheterization. Herein, using cardiac catheterization as reference, we tested the hypothesis that follow-up echocardiography is adequate for clinical decision-making in these patients. We prospectively studied 69 consecutive patients with CTD-associated PAH. Invasive baseline pulmonary artery systolic pressure (PASP) was 60.19 ± 16.33 mmHg (mean ± SD) and pulmonary vascular resistance (PVR) was 6.44 ± 2.95WU. All patients underwent hemodynamic and echocardiographic follow-up after 9.47 ± 7.29 months; 27 patients had a third follow-up after 17.2 ± 7.4 months from baseline. We examined whether clinically meaningful hemodynamic deterioration of follow-up catheterization-derived PASP (i.e., > 10% increase) could be predicted by simultaneous echocardiography. Echocardiography predicted hemodynamic PASP deterioration with 59% sensitivity, 85% specificity, and 63/83% positive/negative predictive value, respectively. In multivariate analysis, successful echocardiographic prediction correlated only with higher PVR in previous catheterization (p = 0.05, OR = 1.235). Notably, in patients having baseline PVR > 5.45 WU, echocardiography had both sensitivity and positive predictive values of 73%, and both specificity and negative predictive value of 91% for detecting hemodynamic PASP deterioration. In selected patients with CTD-PAH echocardiography can predict PASP deterioration with high specificity and negative predictive value. Additional prospective studies are needed to confirm that better patient selection can increase the ability of standard echocardiography to replace repeat catheterization.

The diagnostic and prognostic value of growth differentiation factor‐15 in systemic lupus erythematosus‐associated pulmonary arterial hypertension

“… 4 , 21 , 22 , 23 Among the determinants of prognosis included in the risk stratification, hemodynamic parameters directly reflect the heart function but require an invasive procedure. 24 Thus, serum biomarkers, such as BNP/NT‐proBNP, are widely used in PAH as surrogate markers of cardiac function. 25 NT‐proBNP is the inactive form of Pro‐BNP, which is a pro‐hormone produced mainly by the ventricles, and is secreted by cardiomyocytes.…”

“…In both PAH and SLE‐PAH, TGA is associated with long‐term transplant‐free survival 4,21–23 . Among the determinants of prognosis included in the risk stratification, hemodynamic parameters directly reflect the heart function but require an invasive procedure 24 . Thus, serum biomarkers, such as BNP/NT‐proBNP, are widely used in PAH as surrogate markers of cardiac function 25 .…”