In systemic sclerosis, the TAPSE/sPAP ratio can be used in addition to the DETECT algorithm for pulmonary arterial hypertension diagnosis

Colalillo, Amalia; Grimaldi, Maria Chiara; Vaiarello, Valentina; Pellicano, Chiara; Leodori, Giorgia; Gigante, Antonietta; Romaniello, A.; Rosato, Edoardo

doi:10.1093/rheumatology/keab748

Cited by 12 publications

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References 29 publications

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“…Exercise tests may unmask impaired RV function when the right ventricle at rest still looks normal and functions well. TAPSE/sPAP ratio has already been shown to be crucial for the identification of patients at risk for PH and has been used as tool to identify SSc patients in need of more extensive diagnostics by RHC [41]. The identification of RV output reserve as an independent risk factor in this study confirms the crucial role of exercise testing in patients with SSc to identify early stages of pulmonary hypertension which has been highlighted before [4,13,[54][55][56].…”

Section: Prognostic Meaning Of Rv Function and Reserve In Different E...supporting

confidence: 73%

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Prognostic meaning of right ventricular function and output reserve in patients with systemic sclerosis

et al. 2022

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Background The objective of this study was to investigate the prognostic impact of right ventricular (RV) function at rest and during exercise in patients with systemic sclerosis (SSc) presenting for a screening for pulmonary hypertension (PH). Methods In this study, data from SSc patients who underwent routinely performed examinations for PH screening including echocardiography and right heart catheterization at rest and during exercise were analysed. Uni- and multivariable analyses were performed to identify prognostic parameters. Results Out of 280 SSc patients screened for PH, 225 were included in the analysis (81.3% female, mean age 58.1±13.0 years, 68% limited cutaneous SSc, WHO-FC II–III 74%, 24 manifest PH). During the observation period of 3.2±2.7 (median 2.6) years 35 patients died. Tricuspid annular plane systolic excursion (TAPSE) at rest <18 mm (p=0.001), RV output reserve as increase of cardiac index (CI) during exercise <2 l/min (p<0.0001), RV pulmonary vascular reserve (Δ mean pulmonary artery pressure/Δ cardiac output) ≥3 mmHg/l/min (p<0.0001), peak CI <5.5 l/min/m2 (p=0.001), pulmonary arterial compliance <2 ml/mmHg (p=0.002), TAPSE/systolic pulmonary arterial pressure (sPAP) ratio ≤0.6 ml/mmHg (p<0.0001) and echocardiographic qualitative RV function at rest (p<0.0001) significantly predicted worse survival. In the multivariable analysis TAPSE/sPAP ratio and diffusion capacity for carbon monoxide ≤65% were identified as independent prognostic predictors and had 75% sensitivity and 69% specificity to predict future development of pulmonary vascular disease (PVD) during follow-up. Conclusions This study demonstrates that assessment of RV function at rest and during exercise may provide crucial information to identify SSc patients who are at a high risk of poor outcome and for the development of PH and/or PVD.

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Section: Prognostic Meaning Of Rv Function and Reserve In Different E...supporting

confidence: 73%

“…Known thresholds for the above-listed parameters include TAPSE <18 mm, having already shown prognostic significance [39,40], TAPSE/sPAP ratio ≤0.6 mm/ mmHg [41] and RV pulmonary vascular reserve of ≥3 ml/min/mmHg [42], which has been used as the definition of exercise pulmonary hypertension [43].…”

Section: Parameters Of Right Ventricular Function and Reservementioning

confidence: 99%

Prognostic meaning of right ventricular function and output reserve in patients with systemic sclerosis

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“…TAPSE/sPAP ratio is a powerful predictor of all-cause mortality in patients with PAH. In SSc patients, TAPSE/ sPAP ratio can be used to further select patients requiring right heart catheterization to confirm PAH diagnosis and it showed the best correlation with ventilatory efficiency and exercise capacity [27,28]. There are no data in the literature showing the role of sST2 in right ventricular dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Interleukin-33 and soluble suppression of tumorigenicity 2 in scleroderma cardiac involvement

et al. 2022

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Interleukin (IL)-33 is part of the IL-1 family of cytokines and soluble suppression of tumorigenicity 2 (sST2) is part of the family of IL-1 receptors. In systemic sclerosis (SSc), IL-33 and sST2 are involved in cardiac manifestations such as diastolic dysfunction (DD), autonomic dysfunction (AD) and right ventricular–pulmonary arterial coupling assessed by tricuspid annular plane systolic excursion (TAPSE)/systolic pulmonary artery pressure (sPAP). Serum levels of IL33 and sST2 were assessed in 50 SSc patients and 14 healthy controls (HC). Clinical assessment, echocardiography and heart rate variability (HRV) analysis were performed in SSc patients. Serum levels of IL-33 and sST2 were significantly higher in SSc patients than HC. A linear positive correlation between modified Rodnan skin score and IL33 was observed. Serum values of sST2 were higher in SSc patients with DD than in patients without DD [15403 pg/ml (12,208–19,941) vs 8556 pg/ml (6820–11,036), p < 0.001]. sST2 showed a negative correlation with standard deviation of normal-to-normal RR intervals (SDNN) (r = − 0.281, p < 0.05) and positive correlation with low frequency/high frequency (LF/HF) (r = 0,349, p < 0.01). Negative linear correlation exists between sST2 and TAPSE/sPAP (r = − 0.398, p < 0.01). Serum levels of IL-33 and sST2 are higher in SSc patients than HC. Serum levels of sST2 are a potential marker of DD, AD and right ventricular–pulmonary arterial coupling.

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“…In clinical practice, sPAP is the most used echocardiograpic parameter to evaluate PAH. In our previous study, we demonstrated that in SSc patients with a DETECT algorithm step 2 total score > 35 TAPSE/sPAP ratio can be used to further select patients requiring RHC to confirm PAH diagnosis [14]. Dumitrescu et al investigated the role of CPET in early PAH detection in a prospective study of 173 SSc patients, without known PAH, who also underwent RHC.…”

Section: Discussionmentioning

confidence: 99%

In systemic sclerosis TAPSE/sPAP ratio is correlated with ventilatory efficiency and exercise capacity assessed by CPET

et al. 2022

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Objectives The aim of the study was to evaluate the correlation between cardiopulmonary exercise testing (CPET) parameters and right ventricular echocardiographic parameters for pulmonary arterial hypertension screening in a cohort of systemic sclerosis (SSc) patients. Methods forty SSc patients were examined using CPET and resting transthoracic echocardiography. CPET parameters analyzed were minute ventilation/carbon dioxide production (VE/VCO2) slope and maximum oxygen uptake (VO2 max); echocardiographic parameters were systolic pulmonary artery pressure (sPAP), tricuspid annular plane systolic excursion (TAPSE), and TAPSE/sPAP ratio. Results a positive correlation was observed between VE/VCO2 slope and age (r = 0.415, p < 0.01) and sPAP (r = 0.461, p < 0.01), conversely, a negative correlation was found between VE/VCO2 slope and TASPE/sPAP ratio (r = − 0.521, p = 0.001). VO2 max showed an inverse correlation with age (r = − 0.367, p < 0.05) and sPAP (r = − 0.387, p < 0.05) and a positive correlation with TAPSE/sPAP ratio (r = 0.521, p < 0.01). On stepwise linear regression analysis, VE/VCO2 slope was significantly correlated with TAPSE/sPAP ratio (β coefficient = − 0.570; p < 0.0001), as well as VO2 max was significantly correlated with TAPSE/sPAP ratio (β coefficient = 0.518; p = 0.001). Conclusion in SSc patients, TAPSE/sPAP ratio is the echocardiographic parameter of RV function which showed the best correlation with ventilatory efficiency and exercise capacity.

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In systemic sclerosis, the TAPSE/sPAP ratio can be used in addition to the DETECT algorithm for pulmonary arterial hypertension diagnosis

Cited by 12 publications

References 29 publications

Prognostic meaning of right ventricular function and output reserve in patients with systemic sclerosis

Prognostic meaning of right ventricular function and output reserve in patients with systemic sclerosis

Interleukin-33 and soluble suppression of tumorigenicity 2 in scleroderma cardiac involvement

In systemic sclerosis TAPSE/sPAP ratio is correlated with ventilatory efficiency and exercise capacity assessed by CPET

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