title: Right ventricular systolic pressure assessed by echocardiography: a predictive factor of mortality in patients with scleroderma.
abstract: BACKGROUND
  Pulmonary arterial hypertension (PAH) is a well-known complication of systemic sclerosis (SSc). Doppler echocardiographic screening for the detection of PAH (by measuring right ventricular systolic pressure [RVSP]) is therefore recommended for all patients with SSc. However, the validity of RVSP as a predictor of mortality in patients with SSc is not well established.
  
  
  OBJECTIVE
  Doppler-determined PAH identifies a high-risk subset of patients with SSc with decreased survival.
  
  
  METHODS
  We performed echocardiography in 155 consecutive patients with SSc between May 2005 and July 2006 and tested the value of an RVSP level of ≥36 mm Hg to predict mortality. Cox proportional hazards model was used to examine the individual relationship between each variable and the mortality rate.
  
  
  RESULTS
  Tricuspid regurgitant jets for RVSP determination were quantified in 129 patients (82.6%), of which 47 (36.4%) had RVSP ≥36 mm Hg. The median follow-up time was 34 months. The 1-, 2-, and 3-year survival rates were significantly lower among SSc patients with RVSP ≥36 vs ≤36 mm Hg (82%, 78%, and 67% vs 98%, 90%, and 86%, respectively, P < 0.01 by Wilcoxon test). In a multivariate analysis including echocardiographic and clinical variables, only an RVSP ≥36 mm Hg and a New York Heart Association III/IV class were associated with increased mortality; the respective Cox hazard ratios were 2.22 (95% confidence interval [CI]: 1.01-4.89, P = 0.048) and 4.77 (95% CI: 2.09-10.90, P = 0.000).
  
  
  CONCLUSIONS
  Our results indicate that Doppler RVSP identifies a high-risk subset and supports the use of Doppler RVSP as a screening test in patients with SSc who may warrant early treatment of their PAH.
authors: Division of Cardiology, Department of Medicine, Khon Kaen University, Khon Kaen, Thailand. sonkia@kku.ac.th
authors: Songsak
authors: S
authors: Kiatchoosakun
authors: Chaiyasith
authors: C
authors: Wongvipaporn
authors: Ratanavadee
authors: R
authors: Nanagara
authors: Brian D
authors: BD
authors: Hoit
mesh_terms: D000328:Adult; D001794:Blood Pressure; D015150:Echocardiography, Doppler; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D013785:Thailand / Q000453:epidemiology; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D016278:Ventricular Function, Right; D017725:Ventricular Pressure