Performance of the DETECT Algorithm for Pulmonary Hypertension Screening in a Systemic Sclerosis Cohort

Abstract

Objective Pulmonary arterial hypertension (PAH) is one of the leading causes of mortality in systemic sclerosis (SSc). This study was undertaken to assess predictive accuracies of the DETECT algorithm and the 2015 European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines in SSc patients who underwent right‐sided heart catheterization (RHC) for pulmonary hypertension (PH) evaluation. Methods Patients with SSc who had diagnostic RHC, had no PH or had PAH, and had available data on variables to allow application of the DETECT and 2015 ESC/ERS guidelines were included for analysis. PH classification was based on hemodynamics using the 2018 revised criteria and extent of lung fibrosis shown on high‐resolution computed tomography. Sensitivity and predictive accuracies of the DETECT algorithm and 2015 ESC/ERS guidelines were calculated, including analysis of subjects with a diffusing capacity for carbon monoxide (DLco) of ≥60% predicted. Results Sixty‐eight patients with SSc had RHC, of whom 58 had no PH and 10 had PAH. The mean age was 60.0 years, and 58.8% had limited cutaneous SSc. The DETECT algorithm had a sensitivity of 1.00 (95% confidence interval [95% CI] 0.69–1.00) and a negative predictive value (NPV) of 1.00 (95% CI 0.80–1.00), whereas the 2015 ESC/ERS guidelines had a sensitivity of 0.80 (95% CI 0.44–0.97) and an NPV of 0.94 (95% CI 0.81–0.99). In patients with a DLco of ≥60% (n = 27), the DETECT algorithm had a sensitivity of 1.00 (95% CI 0.29–1.00) and an NPV of 1.00 (95% CI 0.59–1.00), whereas the 2015 ESC/ERS guidelines had a sensitivity of 0.67 (95% CI 0.09–0.99) and an NPV of 0.94 (95% CI 0.71–1.00). Conclusion The DETECT algorithm has high sensitivity and NPV for diagnosis of PAH, including among individuals with a DLco of ≥60%.

Impact of Three Different Algorithms for the Screening of SSc-PAH and Comparison with the Decisions of a Multidisciplinary Team

“…Our study confirms the high sensitivity of the DETECT algorithm, as already reported in previous studies [25][26][27][28]. There did not seem to be any PAH that went undiagnosed by DETECT in our work.…”

“…This new definition now includes PVR ≥ 3 WU as a diagnostic condition, whereas it had been unnecessary in the previous PAH definition. Using the updated PAH definition, Young et al [27] recently confirmed a sensitivity of 1 for the DETECT algorithm and of 0.8 for the ESC/ERS 2015 guidelines, even for patients with DLCO > 60% predicted. However, the reported specificity of DETECT decreased from 0.33 to 0.29 because of the application of the 2018 PAH definition.…”

“…Our study had several limitations, mainly its single-center design and the absence of systematic RHC, which is the reference standard to assess the strength of a screening strategy. To our knowledge, systematic RHC has been performed in only two studies [14,27] that were dedicated to the DETECT algorithm. In our study, among patients with baseline recommendation of RHC according to DETECT or ASIG, none showed clinical/biological/echocardiographic worsening during the 3-year follow-up period, suggesting that no PAH was missed by the MDT, although the absence of systematic RHC precludes firm conclusions.…”

Systemic Sclerosis–Associated Interstitial Lung Disease: How to Incorporate Two Food and Drug Administration–Approved Therapies in Clinical Practice

“…Other causes of progressive symptoms such as pulmonary | 17 vascular disease or cardiac involvement should also be considered due to the multifactorial nature of SSc-associated manifestations. In SSc patients without ILD or with stable or controlled ILD after the first 3-5 years, annual PFTs are useful to monitor for both the onset and progression of SSc-ILD and to screen for SScassociated pulmonary arterial hypertension (PAH) (7,59).…”

“…After this period of close monitoring, all patients should undergo annual PFT, as late progression may occur despite long-term stabilization. Screening for other visceral manifestations, especially PAH, should also be continued according to published screening algorithms (59).…”