Session Information
Date: Tuesday, November 10, 2015
Title: Systemic Sclerosis, Fibrosing Syndromes, and Raynaud's - Clinical Aspects and Therapeutics II
Session Type: ACR Concurrent Abstract Session
Session Time: 2:30PM-4:00PM
Background/Purpose: Pulmonary arterial hypertension (PAH) is the leading
cause of mortality in systemic sclerosis (SSc), and is associated with a 3-year
survival of approximately 50%. Early screening for SSc-PAH may improve survival.
We compared the predictive accuracy of three recently published screening
algorithms – DETECT 2013, Australian Scleroderma Interest Group (ASIG) 2012,
Cochin risk prediction score (RPS) 2011 – for SSc-PAH.
Methods: We included consecutive SSc patients with suspected
PAH undergoing right heart catheterization (RHC). The inclusion criteria were based
on 2013 recommendations for screening PAH (Khanna D. Arthritis Rheum. 2013). The
three screening models were applied to each patient. For each model,
contingency table analysis was used to determine sensitivity, specificity, and
positive (PPV) and negative (NPV) predictive values for PAH [defined as mean
pulmonary artery pressure (mPAP) > or = 25,
pulmonary capillary wedge pressure (PCWP) < or = 15, and no/mild interstitial
lung disease (ILD) on high-resolution CT scan of chest (HRCT), or FVC > or =
70%], WHO group 2 pulmonary hypertension (PH defined as mPAP
> or = 25, PCWP >15, and no / Mild ILD on HRCT, or FVC > or = 70%), and
WHO group 3 PH (defined as mPAP > or = 25, PCWP
< or = 15, and moderate / severe ILD on HRCT, or FVC <70%).
Results: Of the 108 patients screened for PAH, 77 met the
recommendations, and 60 patients had the RHC. The prevalence of PAH was 18%. Figure
1 provides a flowchart of patients screened for PAH. There were no significant
differences in the baseline clinical characteristics between the PH and non-PH
patients. Majority of the patients were females (60% vs
57%), had telangiectasia (70% vs 78%) and about a
third of the patients had anticentromere antibody (35% vs
38%). DETECT and ASIG algorithms performed similarly in detecting PAH with
sensitivities and NPV of 100 % (Table 1). Approximately 1/3 of patients who met
the criteria had PAH (PPV 32-38%). In detecting group-2 PH, DETECT and RPS
algorithms had sensitivities and NPV of 100% (Table 1).
Conclusion: In this cohort, the DETECT and ASIG algorithms were
comparable in detecting PAH in the SSc patients.
Figure 1: Flowchart of patients
screened for PAH
Table 1: Summary of the predictive
accuracies (in percentage) of the screening models for PAH in SSc patients
|
|
ASIG
|
DETECT
|
RPS
|
||||||
|
|
PAH |
Group-2 PH |
Group-3 PH |
PAH |
Group-2 PH |
Group-3 PH |
PAH |
Group-2 PH |
Group-3 PH |
|
Positive
|
58 |
47 |
50 |
66 |
60 |
58 |
74 |
73 |
71 |
|
Negative
|
42 |
53 |
50 |
34 |
40 |
42 |
26 |
27 |
29 |
|
Sensitivity
|
100 |
50 |
62 |
100 |
100 |
70 |
91 |
100 |
75 |
|
Specificity
|
53 |
53 |
53 |
45 |
45 |
45 |
32 |
36 |
30 |
|
PPV
|
37 |
12 |
25 |
38 |
22 |
28 |
32 |
22 |
50 |
|
NPV
|
100 |
89 |
85 |
100 |
100 |
83 |
91 |
100 |
83 |
PPV positive predictive value; NPV negative
predictive value; PAH pulmonary arterial hypertension; PH pulmonary
hypertension
To cite this abstract in AMA style:
Nagaraja V, Visovatti SH, Gladue H, Berrocal VJ, Serrano J, McLaughlin V, Khanna D. Screening Algorithm for Pulmonary Hypertension in Systemic Sclerosis – Comparison of Predictive Accuracy of Three Algorithms [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/screening-algorithm-for-pulmonary-hypertension-in-systemic-sclerosis-comparison-of-predictive-accuracy-of-three-algorithms/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/screening-algorithm-for-pulmonary-hypertension-in-systemic-sclerosis-comparison-of-predictive-accuracy-of-three-algorithms/