Electrocardiographic detection of pulmonary hypertension in patients with systemic sclerosis using the ventricular gradient.
BACKGROUND
Pulmonary hypertension (PH) is a leading cause of death in systemic sclerosis (SSc) patients. The current study assessed the ability of the ECG-derived ventricular gradient (VG-RVPO) to detect PH and predict all-cause mortality in PH patients with subtypes of SSc differing in the extent of multi-organ involvement.


METHODS
ECGs were obtained from 196 patients with limited and 77 patients with diffuse SSc included from our screening programme on cardiac complications. The association of the VG-RVPO with (1) the presence of PH, (2) conventional screening parameters and (3) survival in PH patients was assessed.


RESULTS
In limited SSc patients an elevated VG-RVPO corresponded with the presence of PH (-5±12 mV.ms vs -22±16 mV.ms, P<0.01), correlated significantly with conventional screening parameters and had a better diagnostic performance than the presence of a right heart axis (AUC 0.81 vs 0.60; P=0.04). These differences were not observed in patients with diffuse SSc. An elevated VG-RVPO was associated with decreased survival in all SSc patients with PH (3 year survival 30% vs 64%, P=0.02).


CONCLUSIONS
An elevated VG-RVPO is associated with PH in limited SSc patients and with decreased survival in all SSc patients with PH.
Department of Cardiology, Leiden University Medical Center, the Netherlands.
L E
LE
Couperus
Department of Cardiology, Leiden University Medical Center, the Netherlands.
H W
HW
Vliegen
Department of Cardiology, Leiden University Medical Center, the Netherlands.
I R
IR
Henkens
Department of Cardiology, Leiden University Medical Center, the Netherlands.
A C
AC
Maan
Department of Cardiology, Leiden University Medical Center, the Netherlands.
R W
RW
Treskes
Department of Rheumatology, Leiden University Medical Center, the Netherlands.
J K
JK
de Vries
Department of Rheumatology, Leiden University Medical Center, the Netherlands.
A A
AA
Schouffoer
Department of Cardiology, Leiden University Medical Center, the Netherlands.
C A
CA
Swenne
Department of Cardiology, Leiden University Medical Center, the Netherlands.
M J
MJ
Schalij
Department of Cardiology, Leiden University Medical Center, the Netherlands. Electronic address: r.w.c.scherptong@lumc.nl.
R W C
RW
Scherptong
D000368:Aged; D000465:Algorithms; D015984:Causality; D015897:Comorbidity; D003936:Diagnosis, Computer-Assisted; D004562:Electrocardiography / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006352:Heart Ventricles; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015203:Reproducibility of Results; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000175:diagnosis* / Q000401:mortality*; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000401:mortality
Electrocardiogram; Pulmonary hypertension; Right ventricular pressure overload; Systemic sclerosis; Ventricular gradient