Session Information
Date: Monday, November 9, 2015
Title: Systemic Sclerosis, Fibrosing Syndromes and Raynaud's - Clinical Aspects and Therapeutics Poster II
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: To analyze the usefulness of the DETECT protocol (1) for the prediction of pulmonary hypertension (PH) and pulmonary arterial hypertension (PAH) in routine clinical practice in a systemic sclerosis (SSc) clinic.
Methods: All patients with SSc seen in the Rheumatology Department with a right heart cathetherization (RHC) performed between Jan 1998 and May 2015 and with an echocardiography available within 3 months of the RHC were included. The two steps DETECT score was retrospectively obtained. Receiver Operating Characteristic (ROC) curve and area under the curve (AUC) were calculated for the ability of DETECT score to identify PH and PAH patients. Associations of clinical and RHC data, DETECT score, and disparity between PH and PAH diagnosis and DETECT score, were analysed.
Results: The study included 61patients (82% women, 75% limited cutaneous (lc) SSc, 57±15 y). Mean disease duration from first non-Raynaud symptom was 11±10 years. Pulmonary hypertension (PH) was confirmed by RHC in 50 (82%) patients, of those 38 (62%) had PAH. Other causes of PH were pulmonary fibrosis in 10 patients, with associated myocardiopathy in 3. Other 2 patients had non SSc associated valvulopathy. ROC curve showed an elevated discriminatory capacity of the DETECT score for prediction of PH and PAH, with AUC of 0.930 and 0.867 respectively. Disparity between PH in RHC and DETECT score was present in 10 patients. Only one patient, with severe hypertrophic cardiomyopathy and secondary PH had a negative DETECT score. The other 9 patients, 6 with cardiopathy (3 valvulopathy, 3 SSc related cardiomyopathy) had a positive DETECT score but did not present PH in RHC. Other 11 patients presented PH of other causes (1 non SSc valvulopathy, 9 PF, 4 also with SSc cardiomyopathy) Disparity between PH in RHC and DETECT score was more frequent in the presence of any cardiopathy (p<.002), absence of right axis deviation (p<.011) and higher tricuspid jet velocity (TJV)(p<.0001). Disparity between PAH diagnosis and DETECT score was more frequent in males (p=.011), with dcSSc (p=.031), PF (p<.0001) or cardiopathy (p<.0001), higher TJV (p<. 001), lower FVC (p<.001), higher uric acid (p=.007) and less frequent in the absence of right axis deviation (p=.0026) and in ACA+ patients (p=.003). The results were similar when only the 33 patients who would have been included in the DETECT study (disease duration higher than 3 years and DLCO lower than 60%) were analyzed. When the 28 patients who would not have been included in the DETECT study (less than 3 years of disease duration or DLCO higher than 60%), only the presence of dcSSc (p=.013) or cardiomyopathy (p=.013) were associated with disparity between PH in RHC and DETECT score.
Conclusion: The DETECT algorithm performs very well in a routine clinical setting for early detection of PAH and also of PH or other causes in SSc patients. Our results suggest that the algorithm would not perform as well in patients with any type of cardiopathy.
(1) Coghlan JG, Denton CP et al. Evidence-based detection of pulmonary arterial hypertension in systemic sclerosis: the DETECT study. ARD 2014;73:1340-9
To cite this abstract in AMA style:
Olivas Vergara OM, Joven BE, Diaz Anton B, Jiménez C, Martin Lopez M, Escribano P, Carreira PE. Performance of the Detect Protocol for Pulmonary Arterial Detection in Systemic Sclerosis Patients in Clinical Practice [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/performance-of-the-detect-protocol-for-pulmonary-arterial-detection-in-systemic-sclerosis-patients-in-clinical-practice/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/performance-of-the-detect-protocol-for-pulmonary-arterial-detection-in-systemic-sclerosis-patients-in-clinical-practice/