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Updated: Mar 12, 2026
Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
Published on: June 16, 2020
Screening for Pulmonary Hypertension in Interstitial Lung Disease: Preliminary Results from the PHINDER Study
David Zisman1, Sandeep Sahay2, Debabrata Bandyopadhyay3
1Division of Pulmonary Medicine, Cleveland Clinic Florida, 3100 Weston Rd., Weston, FL, 33331, USA. zismand@ccf.org.
Insights
Pulmonary hypertension (PH) complicates interstitial lung disease (ILD), but screening is lacking. The PHINDER study identified key parameters from pulmonary function tests, imaging, and echocardiography to improve early PH detection in ILD patients.
Area of Science:
- Pulmonary Medicine
- Cardiology
- Radiology
Background:
- Interstitial lung disease (ILD) frequently leads to pulmonary hypertension (PH), significantly impacting patient outcomes.
- Current screening for PH in ILD is not standardized, resulting in diagnostic delays and suboptimal treatment.
- The PHINDER study (NCT05776225) was initiated to address this gap by identifying detection parameters for PH in ILD.
Purpose of the Study:
- To identify reliable parameters for the early detection of precapillary pulmonary hypertension (PH) in patients with interstitial lung disease (ILD).
- To develop a structured screening strategy for PH in ILD, improving diagnostic accuracy and timeliness.
Main Methods:
- Prospective, multicenter data collection from patients with ILD, including clinical, physiological, and imaging assessments.
- Definition of precapillary PH: mean pulmonary arterial pressure >20 mmHg, pulmonary artery wedge pressure ≤15 mmHg, and pulmonary vascular resistance (PVR) >2 Wood units (WU).
- Estimation of PH probability using noninvasive evaluations prior to confirmation by right heart catheterization (RHC).
Main Results:
- Preliminary analysis of 190 participants revealed 55% had precapillary PH, with 14% having severe PH (PVR >5 WU).
- Significant parameters associated with precapillary PH included supplemental oxygen use, DLCO, FVC%/DLCO% ratio, RVSP/TAPSE ratio, TR velocity, PA enlargement, PA/aorta diameter ratio, and RV/LV diameter ratio.
- Clinician gestalt assessment showed limited accuracy (60%) for PH detection compared to hemodynamic confirmation.
Conclusions:
- The composite use of pulmonary function testing, lung imaging, and echocardiography shows promise for improving early precapillary PH detection in ILD.
- The PHINDER study's final data will guide the development of a validated, evidence-based screening tool for PH in ILD.
- Establishing thresholds for continuous variables will aid in diagnosing PH in ILD, facilitating timely and accurate screening strategies.
Introduction:
Interstitial lung disease (ILD) is frequently complicated by pulmonary hypertension (PH) resulting in reduced functional capacity, diminished quality of life, and increased mortality. However, standardized screening for PH in ILD is lacking, causing delays in diagnosis and treatment. PHINDER (NCT05776225) is a prospective multicenter study that aims to identify parameters for the detection of PH in ILD.
Methods:
Data were collected prospectively in patients with ILD from predefined routine testing, including clinical, physiological, and imaging assessments. Precapillary PH was defined as mean pulmonary arterial pressure > 20 mmHg, pulmonary artery wedge pressure ≤ 15 mmHg, and pulmonary vascular resistance (PVR) > 2 Wood units (WU). Investigators estimated probability of precapillary PH based on noninvasive evaluations before confirmation by right heart catheterization (RHC).
Results:
Preliminary results included 190 participants; 105 (55%) had precapillary PH and 26 (14%) had severe PH (PVR > 5 WU). Notable parameters associated with precapillary PH included supplemental oxygen use (OR 3.6, p = 0.004), diffusing capacity of the lung for carbon monoxide ([DLCO] OR 0.9, p = 0.005), forced vital capacity % to DLCO % ratio (OR 1.1, p = 0.008), tricuspid annular plane systolic excursion to right ventricular systolic pressure ratio (OR 0.8, p = 0.020), tricuspid regurgitant velocity (OR 4.4, p = 0.006), pulmonary artery (PA) enlargement (OR 10.6, p < 0.001), PA/aorta diameter ratio (OR 1.7, p = 0.004), and right to left ventricle diameter ratio (OR 1.5, p = 0.021). There was a trend toward higher likelihood of PH with higher clinician suspicion of PH before RHC, but gestalt-based assessment showed limited accuracy relative to hemodynamic confirmation (positive predictive value, 59%; negative predictive value, 68%; accuracy, 60%).
Conclusions:
Preliminary findings support the composite use of pulmonary function testing, lung imaging, and echocardiography to improve early detection of precapillary PH in ILD and guide structured screening strategies. The final data set from PHINDER will provide guidance on thresholds for continuous variables with application in diagnosing PH in ILD, facilitating the development of a validated evidence-based screening tool to aid the detection of PH in ILD.
Trail Registration:
NCT05776225.
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