title: Assessment for Pulmonary Artery Hypertension Using Clinical and Echocardiographic Criteria in Patients With Systemic Sclerosis.
abstract: BACKGROUND
  Prognosis of systemic sclerosis (SSc) is affected by pulmonary artery hypertension (PAH).
  
  
  METHODS
  Among 202 patients (mean age: 46.1 ± 13.3 years; 177 women) with SSc, those with a tricuspid regurgitation (TR) jet maximal velocity at 2D-echocardiography (2DE) < 2.8m/second were not considered at high risk for PAH, whereas those with a TR velocity >3m/second or between 2.8 and 3m/second and associated with dyspnea were.
  
  
  RESULTS
  Among 22 patients at risk, 15 (mean age: 50.4 ± 14.3 years) had definite precapillary PAH on right heart catheterization (RHC). The delay period between recognitions of SSc and PAH was 12.9 ± 5.2 years. Dyspnea was present in all 15 patients, 11 (73.3%) being in the New York Heart Association class III or IV. The 2DE showed normal left ventricular geometrics and function (n = 15), enlargement of the right-sided cardiac chambers (n = 12), increased pulmonary arterial resistances with a TR velocity to pulmonary time-velocity integral ratio of > 0.2 (n = 15) and impaired right ventricle function (n = 15). RHC showed severe PAH in all 15 patients (mean pulmonary artery pressure: 48 ± 17mmHg and mean right atrial pressure: 11.8 ± 4.4mmHg) and a reduced cardiac index (2.2L/m²). There was no statistical difference between patients with and without PAH regarding age, sex ratio, duration from onset of disease, diffuse or cutaneous limited type of SSc, Rodnan severity score and presence of digital ulcerations or autoantibodies. Telangiectasia (P = 0.01) and New York Heart Association class III or IV heart failure (P = 0.001) were more frequent in patients with PAH.
  
  
  CONCLUSIONS
  A combined clinical and Doppler-coupled 2DE screening of PAH risk in patients with SSc is useful to select those who can undergo RHC.
authors: Department of Cardiology, service de cardiologie A2, CHU Mustapha Alger, and Cardiology Oncology Research Collaborative Group, University of medicine of Algiers Benyoucef Benkhedda, Algiers, Algeria.
authors: Nadera
authors: N
authors: Methia
authors: Department of Cardiology, service de cardiologie A2, CHU Mustapha Alger, and Cardiology Oncology Research Collaborative Group, University of medicine of Algiers Benyoucef Benkhedda, Algiers, Algeria.
authors: Samia
authors: S
authors: Latreche
authors: Department of Cardiology, service de cardiologie A2, CHU Mustapha Alger, and Cardiology Oncology Research Collaborative Group, University of medicine of Algiers Benyoucef Benkhedda, Algiers, Algeria.
authors: Omar
authors: O
authors: Ait Mokhtar
authors: APHP Hôpital R Muret, Hôpitaux Universitaires de Paris Seine Saint Denis, Sevran, France. Electronic address: jean-jacques.monsuez@aphp.fr.
authors: Jean-Jacques
authors: JJ
authors: Monsuez
authors: Department of Cardiology, service de cardiologie A2, CHU Mustapha Alger, and Cardiology Oncology Research Collaborative Group, University of medicine of Algiers Benyoucef Benkhedda, Algiers, Algeria.
authors: Salim
authors: S
authors: Benkhedda
mesh_terms: D000328:Adult; D000368:Aged; D000462:Algeria / Q000453:epidemiology; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012595:Scleroderma, Systemic / Q000150:complications* / Q000453:epidemiology; D012720:Severity of Illness Index; D014262:Tricuspid Valve Insufficiency / Q000150:complications
keywords: Echocardiography; Pulmonary hypertension; Systemic sclerosis