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Impact of Three Different Algorithms for the Screening of SSc-PAH and Comparison with the Decisions of a
Valentin Coirier1, Céline Chabanne2, Stéphane Jouneau3,4
1Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, F-35238 Rennes, France.
Insights
A multidisciplinary team (MDT) approach for screening pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) significantly reduced right heart catheterizations (RHC) compared to existing algorithms. This MDT strategy shows promise for SSc-PAH screening and patient management.
Area of Science:
- Cardiology
- Rheumatology
- Pulmonary Medicine
Background:
- Pulmonary arterial hypertension (PAH) is a serious complication in systemic sclerosis (SSc).
- Existing screening algorithms for SSc-PAH have varying sensitivities and specificities.
- A multidisciplinary team (MDT) approach may offer a more refined screening strategy.
Purpose of the Study:
- To compare the diagnostic yield of three established SSc-PAH screening algorithms against an MDT meeting's recommendations.
- To evaluate the impact of MDT decisions on the number of right heart catheterizations (RHC) performed.
- To assess the diagnostic accuracy and clinical utility of the MDT approach in SSc-PAH detection.
Main Methods:
- A monocentric longitudinal study included 117 patients with SSc from 2015 to 2018.
- Three screening algorithms (DETECT, ASIG, ESC/ERS 2015) were applied, and their RHC recommendations were compared to MDT decisions.
- MDT members were blinded to algorithm results when making RHC recommendations.
Main Results:
- The MDT recommended RHC for 14% of patients, while algorithms recommended it for 17-41%.
- Seven out of 16 patients who underwent RHC were diagnosed with SSc-PAH.
- No SSc-PAH was diagnosed in patients recommended for RHC by algorithms but not by the MDT.
Conclusions:
- An MDT approach for SSc-PAH screening can significantly reduce the number of RHC procedures.
- The MDT strategy appears effective in identifying patients who truly benefit from RHC.
- Further research is needed to confirm the long-term value of MDT in managing SSc-PAH patients with algorithm-indicated RHC but no confirmed PAH.
Background:
to compare three existing screening algorithms of pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) with the results of a multidisciplinary team (MDT) meeting from a tertiary center.
Methods:
we conducted a monocentric longitudinal study from 2015 to 2018. All patients with SSc according to LeRoy's classification were eligible. Patients were excluded in the case of missing data required by any of the three screening algorithms. The algorithms were applied for each patient at inclusion. Right heart catheterization (RHC) was performed based on the MDT decision. MDT members were all blinded from the results of the three algorithms regarding RHC recommendations. The RHC recommendations of each algorithm were compared with the MDT decision, and the impact on diagnosis and management was evaluated.
Results:
117 SSc patients were consecutively included in the study, and 99 had follow-up data over the three-year duration of the study (10 deaths). Among the 117 patients, the MDT suggested RHC for 16 patients (14%), DETECT algorithm for 28 (24%), ASIG for 48 (41%) and ESC/ERS 2015 for 20 (17%). Among the 16 patients who had RHC, SSc-PAH was diagnosed in seven. Among patients with an initial recommendation of RHC based on at least one algorithm but not according to the MDT meeting, no SSc-PAH was diagnosed during the three-year follow-up. Results were unchanged when the new 2018 definition of PAH was applied instead of the previous definition.
Conclusion:
a MDT approach appears interesting for the screening of SSc-PAH, with a significant reduction of RHC performed in comparison with dedicated algorithms. The specific relevance of a MDT for the management and follow-up of patients with RHC recommended by existing algorithms but with no PAH warrants further studies.
