Echo Doppler Predictors of Pulmonary Artery Hypertension in Patients with Systemic Sclerosis

Frea, Simone; Capriolo, Michele; Marra, Walter Grosso; Cannillo, Margherita; Fusaro, Enrico; Libertucci, Daniela; Morello, Mara; Gaïta, Fiorenzo

doi:10.1111/j.1540-8175.2011.01467.x

Cited by 15 publications

(30 citation statements)

References 33 publications

(44 reference statements)

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“…Recent studies in small selected cohorts have suggested that global speckle-based strain of both the right and left ventricles is reduced in patients with SSc, and is associated with morbidity, especially in patients with concomitant elevation in pulmonary pressures. 5,24-29 Our study complements and significantly adds to the body of data that occult changes in RV myocardial contractility occurs in SSc regardless of pulmonary pressures, and that these changes occur in a specific regional pattern.…”

Section: Discussionsupporting

confidence: 53%

Unique Abnormalities in Right Ventricular Longitudinal Strain in Systemic Sclerosis Patients

Mukherjee

Chung

Ton

et al. 2016

Circ: Cardiovascular Imaging

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Background Cardiac involvement in systemic sclerosis (SSc) adversely affects long-term prognosis, often remaining undetectable despite close clinical examination and 2D echocardiographic monitoring. Speckle derived strain of the right ventricle (RV) was utilized to detect occult abnormalities in regional and global contractility in SSc patients. Methods and Results 138 SSc patients with technically adequate echocardiograms were studied, and compared with 40 age- and gender-matched healthy non-SSc controls. Standard assessment of RV chamber function included tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC). RV longitudinal systolic speckle-derived strain (RVLSS) was assessed in the basal, mid and apical free wall. TAPSE, was not different between groups (p=0.307). While FAC was lower in SSc patients compared to controls (mean 48.9 vs. 55, p=0.002), the mean FAC was still within the normal range (>35). In contrast, RVLSS measures were significantly different between groups, both globally (-20.4 vs -17.7%, p=0.005), and regionally: decreased in the apex (-8.5 vs -17.1%, p<0.0001) and mid segments (-12.4 vs -20.9%, p<0.0001) and increased in the base (-32.2 vs -23.3%, p=0.0001)for SSc group. The regional difference in the base compared to the apex was significantly greater for SSc than controls (p<0.0001 for interaction). The differences observed in regional strain between SSc and control were unchanged after adjusting for RVSP. Conclusions Speckle-derived strain reveals a heterogenous pattern of regional heart strain in SSc that is not detected by conventional measures of function, suggestive of occult RV myocardial disease.

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Section: Discussionsupporting

confidence: 53%

Unique Abnormalities in Right Ventricular Longitudinal Strain in Systemic Sclerosis Patients

Mukherjee

Chung

Ton

et al. 2016

Circ: Cardiovascular Imaging

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“…While in our study PVR echo correlated significantly with PVR cath , accuracy was less than that observed for PA systolic pressure estimation. Frea and colleagues recently examined Doppler parameters in scleroderma patients without pulmonary hypertension and identified TRV/ VTI RVOT ratio, a surrogate of PVR, as one of the strongest predictors for incident PAH in their cohort (22). As such, despite some limitations, there is growing recognition that PVR echo provides clinical insight and further studies are warranted to refine the accuracy of this non-invasive variable specifically in SSc patients.…”

Section: Discussionmentioning

confidence: 99%

“…Lastly, we found RV FAC, another measure of RV systolic function, negatively correlated with RHC assessment. One small study in the scleroderma literature evaluated the prognostic value of FAC and found it did not predict PAH development (22). …”

Section: Discussionmentioning

confidence: 99%

Relation of Novel Echocardiographic Measures to Invasive Hemodynamic Assessment in Scleroderma‐Associated Pulmonary Arterial Hypertension

Gopal

Doldt

Finch

et al. 2014

Arthritis Care & Research

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Objectives Scleroderma (SSc)-associated pulmonary arterial hypertension (PAH) is a major cause of mortality in SSc patients and represents an important diagnostic and therapeutic target. Our aims were to evaluate the relationship between echocardiogram-derived right heart hemodynamics and “gold standard” right heart catheterization (RHC) measurements in a scleroderma population, and investigate whether this relationship is modified by a subset of pulmonary hypertension. Methods We performed right heart catheterization and echocardiography on the same day, with pulmonary function testing in 21 consecutive subjects (age 57 ± 10, 81% female) with scleroderma and pre-capillary pulmonary hypertension. Results RHC measures including PA systolic and mean pressure, and pulmonary vascular resistance (PVR) correlated strongly with echo-derived data. RHC-derived pulmonary vascular resistance was negatively associated with RV systolic performance as measured by tricuspid annular plane systolic excursion (TAPSE, rho −0.70, p < 0.001), tissue Doppler tricuspid s’ velocity (rho −0.68, p 0.002), and RV fractional area change (rho −0.78, p < 0.001). Correlations with TAPSE and s’ velocity were strengthened when FVC%/DLCO% ≥ 1.6 used to identify pure PAH phenotypes in SSc. Bland-Altman analyses demonstrated strong agreement between RHC and echo-derived hemodynamic measures. Conclusions Our findings suggest that echocardiography may play a clinical role in identifying pulmonary hypertension and RV dysfunction non-invasively, particularly in a subset of SSc patients stratified by pulmonary function testing. This method may establish specific disease phenotypes with differential cardiovascular impact and prove useful as a marker of disease progression/risk stratification in SSC patients that warrants further investigation in larger cohorts.

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“…For SSc, however, routine echocardiogram by itself, especially without adequate right ventricular assessment, is insufficient. Echocardiographic measurement of pulmonary artery systolic pressure (PASP), commonly used to assess PAH, is a calculated value based upon measured tricuspid valve regurgitant velocity (TRV) 15 , which is used to calculate PASP according to the modified Bernoulli pressure/velocity equation 16 (P = 4v 2 ), i.e., PASP = 4(TRV) 2 . Although there is a high correlation (0.57 to 0.93) between PASP measured by echocardiography and right heart catheterization 17 , echocardiographic PASP can significantly over-or underestimate invasive PASP, due to problems with image quality, Doppler alignment, and violation of viscosity assumptions in the modified Bernoulli equation.…”

Section: Rheumatologymentioning

confidence: 99%

Hematopoietic Stem Cell Transplantation for Systemic Sclerosis: If You Are Confused, Remember: “It Is a Matter of the Heart”

Burt¹,

Shah²,

Gheorghiade³

et al. 2012

J Rheumatol

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Echo Doppler Predictors of Pulmonary Artery Hypertension in Patients with Systemic Sclerosis

Abstract: This prospective study identified increased values of the two ratios TRV/TVI and TRV/AcT as predictors of PAH in SSc.

Cited by 15 publications

References 33 publications

Unique Abnormalities in Right Ventricular Longitudinal Strain in Systemic Sclerosis Patients

Unique Abnormalities in Right Ventricular Longitudinal Strain in Systemic Sclerosis Patients

Relation of Novel Echocardiographic Measures to Invasive Hemodynamic Assessment in Scleroderma‐Associated Pulmonary Arterial Hypertension

Hematopoietic Stem Cell Transplantation for Systemic Sclerosis: If You Are Confused, Remember: “It Is a Matter of the Heart”

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