Abstract 15226: Right Heart Parameters for Prediction of Exercise Induced Pulmonary Hypertension in Patients With Systemic Sclerosis
Background: Pulmonary hypertension (PH) is a major cause of morbidity and mortality in patients with systemic sclerosis (SS). Exercise induced PH defined as a 20mmHg increase in pulmonary artery systolic pressure (PASP) was used for early detection of PH. This definition was previously validated with right heart catheterization. We sought to evaluate whether right heart assessment on baseline echocardiogram can help identify SS patients with exercise induced PH.
Methods: 67 SS patients with PASP<40 mmHg underwent a treadmill stress echocardiogram with baseline doppler echocardiography. Maximal PASP was measured before and after exercise. 27 patients had exercise induced PH. Right ventricular basal diameter, right atrium area, tricuspid annular plane systolic excursion, pulmonary valve acceleration time (ATp), right ventricular outflow tract velocity time integral (RVOT VTI), and pulmonary vascular resistance were measured on the baseline echocardiogram. Ratio of tricuspid regurgitant velocity to RVOT VTI (TRV/VTI) along with the ratio of tricuspid regurgitant velocity to ATp (TRV/ATp) were also measured. ATp, RVOT VTI, TRV/VTI, TRV/ATp, and pulmonary vascular resistance values were available in 24 patients with exercise induced PH and 27 patients without exercise induced PH.
Results: ATp was significantly shorter in patients with exercise induced PH (128 ± 31 ms vs. 155 ± 27 ms, p=0.002). TRV/ATp ratio was higher in patients with exercise induced PH (20.4 ± 8 vs. 15.2 ± 4, p= 0.008). There were no other statistically significant differences in measured parameters including RVOT VTI and peripheral vascular resistance. The areas under the receiver operated characteristic curves (ROC) were 0.71 and 0.69 for ATp and TRV/ATp respectively.
Conclusion: On baseline doppler echocardiography, ATp and TRV/ATp can help predict exercise induced pulmonary hypertension in patients with systemic sclerosis.
- © 2013 by American Heart Association, Inc.