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Combined peripheral and central ultrasound for the diagnosis of PAH-SSc patients
Michele Correale1, Cinzia Rotondo2, Ester Maria Lucia Bevere3
1Cardiothoracic Department, Policlinico Riuniti University Hospital, Foggia, Italy.
Insights
Systemic sclerosis patients with pulmonary arterial hypertension show impaired endothelial function and abnormal echocardiographic measures. Early detection of these markers can predict right ventricular dysfunction and improve outcomes.
Area of Science:
- Cardiology
- Rheumatology
- Pulmonology
Background:
- Systemic Sclerosis (SSc) is an autoimmune disease causing fibrosis and cardiovascular issues, including pulmonary hypertension (PH).
- Pulmonary arterial hypertension (PAH) significantly impacts survival and quality of life in SSc patients.
- Early detection of PH and right ventricular (RV) dysfunction in SSc is crucial.
Purpose of the Study:
- To evaluate echocardiographic parameters and endothelial function (flow-mediated dilatation, FMD) in SSc patients.
- To differentiate SSc patients with and without PAH.
- To identify early markers of RV vulnerability and PAH in SSc.
Main Methods:
- Fifty-nine SSc patients and 48 healthy controls underwent clinical evaluation, echocardiography, FMD assessment, and blood tests.
- Right heart catheterization (RHC) was performed for PH diagnosis according to ESC/ERS guidelines.
- Echocardiographic parameters (TAPSE, RA area, RVOT, TRV) and FMD were analyzed.
Main Results:
- SSc-PAH patients had lower FMD, reduced TAPSE, larger RA area, slower act RVOT, and higher TRV compared to non-PAH SSc patients and controls.
- Higher resting resistivity index (RI) was observed in SSc patients overall.
- Lower FMD% predicted adverse cardiovascular outcomes in SSc and SSc-PAH patients.
Conclusions:
- Endothelial dysfunction (low FMD) and impaired RV echocardiographic parameters (TAPSE, TRV) are indicative of RV dysfunction and PAH in SSc.
- Early identification of these markers can aid in predicting and managing PAH in SSc.
- FMD% variations stratified by TRV and PAH presence highlight its potential clinical utility.
Background:
Systemic Sclerosis (SSc), an intricate autoimmune disease causing tissue fibrosis, introduces cardiovascular complexities, notably pulmonary hypertension (PH), affecting both survival and quality of life. This study centers on evaluating echocardiographic parameters and endothelial function using flow-mediated dilatation (FMD) in SSc patients, aiming to differentiate those with and without pulmonary arterial hypertension (PAH). The emphasis lies in early detection, given the heightened vulnerability of the right ventricle (RV) in the presence of PH.
Methods:
Fifty-nine SSc patients and 48 healthy subjects participated, undergoing clinical examinations, echocardiography, FMD assessments, blood analyses, and right heart catheterization (RHC) according to the ESC/ERS guidelines for diagnosis and treatment of PH.
Results:
SSc-PAH patients displayed lower FMD, higher frequency of TAPSE < 18 mm, RA area > 18 cm2, act RVOT < 105 ms and TRV > 280 cm/s compared to those without PAH and healthy controls. Resting resistivity index (RI) was higher in SSc patients, with no significant difference between those with and without PAH. Lower FMD% serves as a predictive marker for adverse cardiovascular outcomes in both SSc and SSc-PAH patients. Stratification by TRV levels and PAH presence reveals notable FMD% variations, emphasizing its potential utility.
Conclusions:
Early identification of endothelial dysfunction and impaired RV echocardiographic parameters, such as TAPSE and TRV, could aid in predicting right ventricular dysfunction and PAH in SSc patients.
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