title: Determining the necessity for right heart catheterization in pulmonary hypertension associated with connective tissue diseases assessed by echocardiography.
abstract: OBJECTIVE
  The prognosis of pulmonary hypertension (PH) in systemic sclerosis (SSC) and in systemic lupus erythematosus (SLE) is different. According to the guidelines, right heart catheterization (RHC) is necessary in pulmonary arterial hypertension (PAH) associated with connective tissue diseases (CTD). However, there is little supporting evidence. Therefore, we attempted to determine the necessity for RHC and the causes of differences in prognosis of PH by comparing SSC to SLE.
  
  
  METHODS
  The inclusion criteria were all patients with SSC or SLE with exertional dyspnea. Echocardiography and carotid Doppler ultrasound were performed.
  
  
  RESULTS
  Twenty-three patients with SSC and 23 with SLE participated in this study. There was no difference in the right ventricular systolic pressure (RVSP) between SSC and SLE (33.0 mmHg, range 25.3-41.7 mmHg vs. 32.4 mmHg, range 27.0-37.7 mmHg; P = 0.835). In multiple linear regression analysis, the ratio of peak tricuspid regurgitant velocity to right ventricular outflow tract time-velocity integral, which represents pulmonary vascular resistance (PVR), was correlated with RVSP in SSC (r(2) = 0.928, β = 0.362, P = 0.003), and the independent predictor of increased RVSP was the ratio of early diastolic transmitral filling velocity to early diastolic septal mitral annular velocity, which represents diastolic dysfunction in SLE (R(2) = 0.806, β = 0.803, P = 0.023).
  
  
  CONCLUSIONS
  PVR was an important cause of PH in SSC. Left ventricular dysfunction was an important cause of PH in SLE. Thus, these findings demonstrate the necessity for RHC and differences in prognosis of PH in CTD.
authors.affiliation: Division of Cardiology, Internal Medicine, Jeju National University Hospital, Jeju, Korea.
authors.forename: Joon Hyouk
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Division of Cardiology, Internal Medicine, Jeju National University Hospital, Jeju, Korea.
authors.forename: Seung-Jae
authors.initials: SJ
authors.lastname: Joo
authors.affiliation: Division of Rheumatology, Internal Medicine, School of Medicine, Jeju National University, Jeju, Korea.
authors.forename: Jinseok
authors.initials: J
authors.lastname: Kim
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization; D016009:Chi-Square Distribution; D015150:Echocardiography, Doppler; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D016014:Linear Models; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D017725:Ventricular Pressure
keywords: disease etiology and pathogenesis; systemic lupus erythematous; systemic sclerosis