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Assessment of pulmonary arterial hypertension in patients with systemic sclerosis: comparison of noninvasive tests with results of right-heart catheterization
OBJECTIVE: Pulmonary hypertension (PH) is an ominous complication in patients with scleroderma (systemic sclerosis, SSc). We compared noninvasive assessment of PH with pulmonary artery (PA) pressures obtained by right-heart catheterization (RHC). METHODS: Forty-nine patients with SSc were evaluated...
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| Published in: | Journal of rheumatology 2008-03, Vol.35 (3), p.458-465 |
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| container_end_page | 465 |
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| container_start_page | 458 |
| container_title | Journal of rheumatology |
| container_volume | 35 |
| creator | HSU, Vivien M MOREYRA, Abel E WILSON, Alan C SHINNAR, Meir SHINDLER, Daniel M WILSON, Julianne E DESAI, Ami SEIBOLD, James R |
| description | OBJECTIVE: Pulmonary hypertension (PH) is an ominous complication in patients with scleroderma (systemic sclerosis, SSc).
We compared noninvasive assessment of PH with pulmonary artery (PA) pressures obtained by right-heart catheterization (RHC).
METHODS: Forty-nine patients with SSc were evaluated for suspected PH based on clinical findings, progressive dyspnea, and
pulmonary function tests (PFT). PH was defined as mean PA pressure > or = 25 mm Hg, or > or = 30 mm Hg after exercise, with
normal pulmonary capillary wedge pressure (PCW). Doppler echocardiography (echo) and cardiac magnetic resonance imaging (MRI)
were performed within 4 hours of RHC, and the predictive accuracy of the tests was compared. RESULTS: RHC identified 24/49
(49%) patients with PH. The noninvasive cutpoints were: estimated right ventricular systolic pressure > 47 mm Hg by echo;
diameter of the main PA > 28 mm by MRI; and the ratio of forced vital capacity to diffusion capacity (%FVC/%DLCO) > 2.0 by
PFT. Echo classified 38 subjects correctly (14/24 with and 24/25 without PH; sensitivity 58%, specificity 96%). The area under
receiver-operating characteristic curve (AUC) was 0.84 for echo. MRI measurement of PA diameter had a sensitivity of 68% and
specificity 71% (AUC 0.78). PFT evaluation had a sensitivity of 71% and specificity of 72% (AUC 0.76). CONCLUSION: In evaluation
of SSc with suspected PH, echo appeared to be the most useful among the noninvasive tests, mainly due to the high specificity,
high positive predictive value, and highest AUC. However, due to the low sensitivity of noninvasive testing, RHC should remain
the gold standard. |
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| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_70365772</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>70365772</sourcerecordid><originalsourceid>FETCH-LOGICAL-h269t-c3d9c783df493dfbac6ba5658e9f8d0abed5f040f2c4f1ae0275f851b1296b403</originalsourceid><addsrcrecordid>eNpFkMuO1TAMhisEYg4Dr4CygV2lXJpe2I1G3KSR2IDErnJThwalSYnTqQ4Pw7MSxBnYxLH0-f_t_1F1Es0w1LLT8nF14kroWrTy61X1jOg756Jt2v5pdSV6yZWS_FT9uiFCohVDZtGybfdrDJDODFLG5MCz5bxh-QdyMTAX2AbZFZrY4fLC6EwZV2cYGY8pkqM3zMR1g-So8EUyxODCPZC7R5aRHgYT0u5LU4jkvi25XrBYMgN5wT_OP4tNDM-rJxY84YtLva6-vHv7-fZDfffp_cfbm7t6ke2Qa6PmwXS9mm0zlGcC006gW93jYPuZw4SztrzhVprGCkBeArK9FpOQQzs1XF1Xr__qbin-2MuW4-rIoPcQMO40dly1uutkAV9ewH1acR635NYS1_iQaAFeXQAgA94mCMbRP05y0TW9kP-5pVx_uIQjreB9kVXjcRxKj2psdK9-A9Cpk4s</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>70365772</pqid></control><display><type>article</type><title>Assessment of pulmonary arterial hypertension in patients with systemic sclerosis: comparison of noninvasive tests with results of right-heart catheterization</title><source>Freely Accessible Medical Journals</source><creator>HSU, Vivien M ; MOREYRA, Abel E ; WILSON, Alan C ; SHINNAR, Meir ; SHINDLER, Daniel M ; WILSON, Julianne E ; DESAI, Ami ; SEIBOLD, James R</creator><creatorcontrib>HSU, Vivien M ; MOREYRA, Abel E ; WILSON, Alan C ; SHINNAR, Meir ; SHINDLER, Daniel M ; WILSON, Julianne E ; DESAI, Ami ; SEIBOLD, James R</creatorcontrib><description>OBJECTIVE: Pulmonary hypertension (PH) is an ominous complication in patients with scleroderma (systemic sclerosis, SSc).
We compared noninvasive assessment of PH with pulmonary artery (PA) pressures obtained by right-heart catheterization (RHC).
METHODS: Forty-nine patients with SSc were evaluated for suspected PH based on clinical findings, progressive dyspnea, and
pulmonary function tests (PFT). PH was defined as mean PA pressure > or = 25 mm Hg, or > or = 30 mm Hg after exercise, with
normal pulmonary capillary wedge pressure (PCW). Doppler echocardiography (echo) and cardiac magnetic resonance imaging (MRI)
were performed within 4 hours of RHC, and the predictive accuracy of the tests was compared. RESULTS: RHC identified 24/49
(49%) patients with PH. The noninvasive cutpoints were: estimated right ventricular systolic pressure > 47 mm Hg by echo;
diameter of the main PA > 28 mm by MRI; and the ratio of forced vital capacity to diffusion capacity (%FVC/%DLCO) > 2.0 by
PFT. Echo classified 38 subjects correctly (14/24 with and 24/25 without PH; sensitivity 58%, specificity 96%). The area under
receiver-operating characteristic curve (AUC) was 0.84 for echo. MRI measurement of PA diameter had a sensitivity of 68% and
specificity 71% (AUC 0.78). PFT evaluation had a sensitivity of 71% and specificity of 72% (AUC 0.76). CONCLUSION: In evaluation
of SSc with suspected PH, echo appeared to be the most useful among the noninvasive tests, mainly due to the high specificity,
high positive predictive value, and highest AUC. However, due to the low sensitivity of noninvasive testing, RHC should remain
the gold standard.</description><identifier>ISSN: 0315-162X</identifier><identifier>EISSN: 1499-2752</identifier><identifier>PMID: 18203320</identifier><identifier>CODEN: JRHUA9</identifier><language>eng</language><publisher>Toronto, ON: The Journal of Rheumatology</publisher><subject>Biological and medical sciences ; Blood Pressure Determination - methods ; Catheterization, Swan-Ganz ; Cohort Studies ; Diseases of the osteoarticular system ; Echocardiography, Doppler ; False Positive Reactions ; Humans ; Hypertension, Pulmonary - complications ; Hypertension, Pulmonary - diagnosis ; Magnetic Resonance Imaging ; Medical sciences ; Pneumology ; Pulmonary Artery - pathology ; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases ; Respiratory Function Tests ; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis ; Scleroderma, Systemic - complications ; Sensitivity and Specificity</subject><ispartof>Journal of rheumatology, 2008-03, Vol.35 (3), p.458-465</ispartof><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20174812$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18203320$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>HSU, Vivien M</creatorcontrib><creatorcontrib>MOREYRA, Abel E</creatorcontrib><creatorcontrib>WILSON, Alan C</creatorcontrib><creatorcontrib>SHINNAR, Meir</creatorcontrib><creatorcontrib>SHINDLER, Daniel M</creatorcontrib><creatorcontrib>WILSON, Julianne E</creatorcontrib><creatorcontrib>DESAI, Ami</creatorcontrib><creatorcontrib>SEIBOLD, James R</creatorcontrib><title>Assessment of pulmonary arterial hypertension in patients with systemic sclerosis: comparison of noninvasive tests with results of right-heart catheterization</title><title>Journal of rheumatology</title><addtitle>J Rheumatol</addtitle><description>OBJECTIVE: Pulmonary hypertension (PH) is an ominous complication in patients with scleroderma (systemic sclerosis, SSc).
We compared noninvasive assessment of PH with pulmonary artery (PA) pressures obtained by right-heart catheterization (RHC).
METHODS: Forty-nine patients with SSc were evaluated for suspected PH based on clinical findings, progressive dyspnea, and
pulmonary function tests (PFT). PH was defined as mean PA pressure > or = 25 mm Hg, or > or = 30 mm Hg after exercise, with
normal pulmonary capillary wedge pressure (PCW). Doppler echocardiography (echo) and cardiac magnetic resonance imaging (MRI)
were performed within 4 hours of RHC, and the predictive accuracy of the tests was compared. RESULTS: RHC identified 24/49
(49%) patients with PH. The noninvasive cutpoints were: estimated right ventricular systolic pressure > 47 mm Hg by echo;
diameter of the main PA > 28 mm by MRI; and the ratio of forced vital capacity to diffusion capacity (%FVC/%DLCO) > 2.0 by
PFT. Echo classified 38 subjects correctly (14/24 with and 24/25 without PH; sensitivity 58%, specificity 96%). The area under
receiver-operating characteristic curve (AUC) was 0.84 for echo. MRI measurement of PA diameter had a sensitivity of 68% and
specificity 71% (AUC 0.78). PFT evaluation had a sensitivity of 71% and specificity of 72% (AUC 0.76). CONCLUSION: In evaluation
of SSc with suspected PH, echo appeared to be the most useful among the noninvasive tests, mainly due to the high specificity,
high positive predictive value, and highest AUC. However, due to the low sensitivity of noninvasive testing, RHC should remain
the gold standard.</description><subject>Biological and medical sciences</subject><subject>Blood Pressure Determination - methods</subject><subject>Catheterization, Swan-Ganz</subject><subject>Cohort Studies</subject><subject>Diseases of the osteoarticular system</subject><subject>Echocardiography, Doppler</subject><subject>False Positive Reactions</subject><subject>Humans</subject><subject>Hypertension, Pulmonary - complications</subject><subject>Hypertension, Pulmonary - diagnosis</subject><subject>Magnetic Resonance Imaging</subject><subject>Medical sciences</subject><subject>Pneumology</subject><subject>Pulmonary Artery - pathology</subject><subject>Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases</subject><subject>Respiratory Function Tests</subject><subject>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</subject><subject>Scleroderma, Systemic - complications</subject><subject>Sensitivity and Specificity</subject><issn>0315-162X</issn><issn>1499-2752</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><recordid>eNpFkMuO1TAMhisEYg4Dr4CygV2lXJpe2I1G3KSR2IDErnJThwalSYnTqQ4Pw7MSxBnYxLH0-f_t_1F1Es0w1LLT8nF14kroWrTy61X1jOg756Jt2v5pdSV6yZWS_FT9uiFCohVDZtGybfdrDJDODFLG5MCz5bxh-QdyMTAX2AbZFZrY4fLC6EwZV2cYGY8pkqM3zMR1g-So8EUyxODCPZC7R5aRHgYT0u5LU4jkvi25XrBYMgN5wT_OP4tNDM-rJxY84YtLva6-vHv7-fZDfffp_cfbm7t6ke2Qa6PmwXS9mm0zlGcC006gW93jYPuZw4SztrzhVprGCkBeArK9FpOQQzs1XF1Xr__qbin-2MuW4-rIoPcQMO40dly1uutkAV9ewH1acR635NYS1_iQaAFeXQAgA94mCMbRP05y0TW9kP-5pVx_uIQjreB9kVXjcRxKj2psdK9-A9Cpk4s</recordid><startdate>20080301</startdate><enddate>20080301</enddate><creator>HSU, Vivien M</creator><creator>MOREYRA, Abel E</creator><creator>WILSON, Alan C</creator><creator>SHINNAR, Meir</creator><creator>SHINDLER, Daniel M</creator><creator>WILSON, Julianne E</creator><creator>DESAI, Ami</creator><creator>SEIBOLD, James R</creator><general>The Journal of Rheumatology</general><general>Journal of Rheumatology Publishing</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>20080301</creationdate><title>Assessment of pulmonary arterial hypertension in patients with systemic sclerosis: comparison of noninvasive tests with results of right-heart catheterization</title><author>HSU, Vivien M ; MOREYRA, Abel E ; WILSON, Alan C ; SHINNAR, Meir ; SHINDLER, Daniel M ; WILSON, Julianne E ; DESAI, Ami ; SEIBOLD, James R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-h269t-c3d9c783df493dfbac6ba5658e9f8d0abed5f040f2c4f1ae0275f851b1296b403</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Biological and medical sciences</topic><topic>Blood Pressure Determination - methods</topic><topic>Catheterization, Swan-Ganz</topic><topic>Cohort Studies</topic><topic>Diseases of the osteoarticular system</topic><topic>Echocardiography, Doppler</topic><topic>False Positive Reactions</topic><topic>Humans</topic><topic>Hypertension, Pulmonary - complications</topic><topic>Hypertension, Pulmonary - diagnosis</topic><topic>Magnetic Resonance Imaging</topic><topic>Medical sciences</topic><topic>Pneumology</topic><topic>Pulmonary Artery - pathology</topic><topic>Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases</topic><topic>Respiratory Function Tests</topic><topic>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</topic><topic>Scleroderma, Systemic - complications</topic><topic>Sensitivity and Specificity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>HSU, Vivien M</creatorcontrib><creatorcontrib>MOREYRA, Abel E</creatorcontrib><creatorcontrib>WILSON, Alan C</creatorcontrib><creatorcontrib>SHINNAR, Meir</creatorcontrib><creatorcontrib>SHINDLER, Daniel M</creatorcontrib><creatorcontrib>WILSON, Julianne E</creatorcontrib><creatorcontrib>DESAI, Ami</creatorcontrib><creatorcontrib>SEIBOLD, James R</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of rheumatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>HSU, Vivien M</au><au>MOREYRA, Abel E</au><au>WILSON, Alan C</au><au>SHINNAR, Meir</au><au>SHINDLER, Daniel M</au><au>WILSON, Julianne E</au><au>DESAI, Ami</au><au>SEIBOLD, James R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessment of pulmonary arterial hypertension in patients with systemic sclerosis: comparison of noninvasive tests with results of right-heart catheterization</atitle><jtitle>Journal of rheumatology</jtitle><addtitle>J Rheumatol</addtitle><date>2008-03-01</date><risdate>2008</risdate><volume>35</volume><issue>3</issue><spage>458</spage><epage>465</epage><pages>458-465</pages><issn>0315-162X</issn><eissn>1499-2752</eissn><coden>JRHUA9</coden><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>OBJECTIVE: Pulmonary hypertension (PH) is an ominous complication in patients with scleroderma (systemic sclerosis, SSc).
We compared noninvasive assessment of PH with pulmonary artery (PA) pressures obtained by right-heart catheterization (RHC).
METHODS: Forty-nine patients with SSc were evaluated for suspected PH based on clinical findings, progressive dyspnea, and
pulmonary function tests (PFT). PH was defined as mean PA pressure > or = 25 mm Hg, or > or = 30 mm Hg after exercise, with
normal pulmonary capillary wedge pressure (PCW). Doppler echocardiography (echo) and cardiac magnetic resonance imaging (MRI)
were performed within 4 hours of RHC, and the predictive accuracy of the tests was compared. RESULTS: RHC identified 24/49
(49%) patients with PH. The noninvasive cutpoints were: estimated right ventricular systolic pressure > 47 mm Hg by echo;
diameter of the main PA > 28 mm by MRI; and the ratio of forced vital capacity to diffusion capacity (%FVC/%DLCO) > 2.0 by
PFT. Echo classified 38 subjects correctly (14/24 with and 24/25 without PH; sensitivity 58%, specificity 96%). The area under
receiver-operating characteristic curve (AUC) was 0.84 for echo. MRI measurement of PA diameter had a sensitivity of 68% and
specificity 71% (AUC 0.78). PFT evaluation had a sensitivity of 71% and specificity of 72% (AUC 0.76). CONCLUSION: In evaluation
of SSc with suspected PH, echo appeared to be the most useful among the noninvasive tests, mainly due to the high specificity,
high positive predictive value, and highest AUC. However, due to the low sensitivity of noninvasive testing, RHC should remain
the gold standard.</abstract><cop>Toronto, ON</cop><pub>The Journal of Rheumatology</pub><pmid>18203320</pmid><tpages>8</tpages></addata></record> |
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| ispartof | Journal of rheumatology, 2008-03, Vol.35 (3), p.458-465 |
| issn | 0315-162X 1499-2752 |
| language | eng |
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| source | Freely Accessible Medical Journals |
| subjects | Biological and medical sciences Blood Pressure Determination - methods Catheterization, Swan-Ganz Cohort Studies Diseases of the osteoarticular system Echocardiography, Doppler False Positive Reactions Humans Hypertension, Pulmonary - complications Hypertension, Pulmonary - diagnosis Magnetic Resonance Imaging Medical sciences Pneumology Pulmonary Artery - pathology Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases Respiratory Function Tests Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis Scleroderma, Systemic - complications Sensitivity and Specificity |
| title | Assessment of pulmonary arterial hypertension in patients with systemic sclerosis: comparison of noninvasive tests with results of right-heart catheterization |
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