title: Echo Doppler predictors of pulmonary artery hypertension in patients with systemic sclerosis.
abstract: OBJECTIVE
  Evaluate echocardiographic predictors of pulmonary artery hypertension (PAH) in a prospective cohort of patients with systemic sclerosis (SSc).
  
  
  METHODS
  38 patients with SSc who did not have PAH and significant left heart disease, with peak tricuspid regurgitant velocity (TRV) ≤ 2.8 m/sec and systolic pulmonary artery pressure (sPAP) < 40 mmHg on echo Doppler were enrolled. Patients underwent: clinical assessment, NT-proBNP, and DLco measurements. Echo Doppler evaluation included right ventricular (RV) dimensions, tricuspid annular plan systolic excursion, fractional area change, tricuspid DTI systolic velocity, Tei index, pulmonary flow acceleration time (AcT), ratio of TRV to RV outflow tract time-velocity integral (TVI) and a parameter of disturbed RV ejection (TRV/AcT). After a planned 12-month follow-up we evaluated the predictive value of these parameters for the development of PAH, as demonstrated by right heart catheterization (RHC). Criteria for RHC were TRV ≥ 3 m/sec or sPAP ≥ 40 mmHg.
  
  
  RESULTS
  Four patients developed PAH. Only TRV/TVI and TRV/AcT ratios significantly predicted PAH development (TRV/TVI ratio ≥ 0.16 [predefined and ROC confirmed]: OR 99, CI 95%: 4.865-2015, P = 0.004; TRV/AcT ratio ≥ 0.022 [predefined and ROC confirmed]: OR 12.68, CI 95% 1.163-379.3, P = 0.036). Both parameters showed a good diagnostic power (TRV/TVI ratio: ROC area 79%, sensitivity 75%, specificity 97% and diagnostic accuracy 94.74% for cutoff value of 0.16; TRV/AcT ratio: ROC area 75%, sensitivity 75%, specificity 71% and diagnostic accuracy 72% for cutoff value of 0.022).
  
  
  CONCLUSIONS
  This prospective study identified increased values of the two ratios TRV/TVI and TRV/AcT as predictors of PAH in SSc.
authors: Division of Cardiology, Cardiovascular and Thoracic Department, AOU S. Giovanni Battista di Torino and University of Torino, Torino, Italy. simone.frea@libero.it
authors: Simone
authors: S
authors: Frea
authors: Michele
authors: M
authors: Capriolo
authors: Walter Grosso
authors: WG
authors: Marra
authors: Margherita
authors: M
authors: Cannillo
authors: Enrico
authors: E
authors: Fusaro
authors: Daniela
authors: D
authors: Libertucci
authors: Mara
authors: M
authors: Morello
authors: Fiorenzo
authors: F
authors: Gaita
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D015150:Echocardiography, Doppler; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011652:Pulmonary Circulation; D012595:Scleroderma, Systemic / Q000150:complications*; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D014261:Tricuspid Valve / Q000000981:diagnostic imaging; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging