Tricuspid flow propagation velocity predicts exercise tolerance and readmission in patients with systemic lupus erythematosus.
BACKGROUND
Evaluating right ventricular dysfunction, pulmonary artery systolic pressure (PASP), and exercise tolerance is critical in patients with systemic lupus erythematosus (SLE) because of the high mortality rate in such patients with pulmonary arterial hypertension (PAH). The aim of this study was to use the flow propagation velocity (FPV) of early diastolic tricuspid inflow to evaluate exercise tolerance and PAH severity and to predict readmission in patients with SLE.


METHODS
A total of 66 patients with SLE with or without PAH and 30 healthy control subjects were enrolled. Controls were age-matched to patients with SLE and without PAH. All patients completed the 6-minute walking distance (6MWD) test and underwent standard echocardiography. Tricuspid FPV was measured in the modified parasternal short-axis view using the color M-mode technique. PAH was defined as PASP > 35 mm Hg using the tricuspid regurgitant method.


RESULTS
Patients with SLE and PAH had significantly lower tricuspid FPVs and 6MWDs than patients in the other 2 groups (both P values < .001). Tricuspid FPV was well correlated with 6MWD (r = 0.748, P < .001). In multivariate analysis, right atrial pressure was the only independent factor affecting tricuspid FPV (R(2) = 0.394, P < .001), and 6MWD was affected only by tricuspid FPV and PASP (R(2) = 0.629, P < .001). Patients with SLE who had been readmitted had lower tricuspid FPVs than those who had not (P = .035). Furthermore, FPV > or = 35.4 cm/s predicted 6MWD > or = 350 m and a lower 1-year readmission rate with good sensitivity and specificity.


CONCLUSIONS
The tricuspid FPV technique provides a simple method for predicting exercise tolerance, the severity of PAH, and readmission among patients with SLE.
Cheng
Chin-Chang
CC
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China.
Huang
Wei-Chun
WC
Chiou
Kuan-Rau
KR
Hsiao
Shih-Hung
SH
Lin
Shih-Kai
SK
Lu
Ling-Ying
LY
Tseng
Jui-Cheng
JC
Hu
Jui-Chieh
JC
Mar
Guang-Yuan
GY
Chiou
Chuen-Wang
CW
Lin
Shoa-Lin
SL
Liu
Chun-Peng
CP
D000328:Adult; D001783:Blood Flow Velocity; D015897:Comorbidity; D004452:Echocardiography / Q000706:statistics & numerical data*; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D015994:Incidence; D008180:Lupus Erythematosus, Systemic / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013624:Taiwan / Q000453:epidemiology; D014261:Tricuspid Valve / Q000000981:diagnostic imaging*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000453:epidemiology*