Cardiopulmonary Exercise Testing in a Combined Screening Approach to Individuate Pulmonary Arterial Hypertension in Systemic Sclerosis

Overview

Journal Rheumatology (Oxford)

Publisher Oxford University Press

Specialty Rheumatology

Date 2019 Oct 23

PMID 31637433

Citations 11

Authors

Alessandro Santaniello

Rosa Casella

Marco Vicenzi

Irene Rota

Gaia Montanelli

Maria De Santis

Chiara Bellocchi

Federico Lombardi

Lorenzo Beretta

Affiliations

Soon will be listed here.

Abstract

Objectives: The DETECT algorithm has been developed to identify SSc patients at risk for pulmonary arterial hypertension (PAH) yielding high sensitivity but low specificity, and positive predictive value. We tested whether cardiopulmonary exercise testing (CPET) could improve the performance of the DETECT screening strategy.

Methods: Consecutive SSc patients over a 30-month period were screened with the DETECT algorithm and positive subjects were referred for CPET before the execution of right-heart catheterization. The predictive performance of CPET on top of DETECT was evaluated and internally validated via bootstrap replicates.

Results: Out of 314 patients, 96 satisfied the DETECT application criteria and 54 were positive. PAH was ascertained in 17 (31.5%) and pre-capillary pulmonary hypertension in 23 (42.6%) patients. Within CPET variables, the slope of the minute ventilation to carbon dioxide production relationship (VE/VCO2 slope) had the best performance to predict PAH at right-heart catheterization [median (interquartile range) of specificity 0.778 (0.714-0.846), positive predictive value 0.636 (0.556-0.750)]; exploratory analysis on pre-capillary yielded a specificity of 0.714 (0.636-0.8) and positive predictive value of 0.714 (0.636-0.8).

Conclusion: In association with the DETECT algorithm, CPET may be considered as a useful tool in the workup of SSc-related pulmonary hypertension. The sequential determination of the VE/VCO2 slope in DETECT-positive subjects may reduce the number of unnecessary invasive procedures without any loss in the capability to capture PAH. This strategy had also a remarkable performance in highlighting the presence of pre-capillary pulmonary hypertension.

Citing Articles

Cardiopulmonary Exercise Testing: Deciphering Cardiovascular Complications in Systemic Sclerosis.

Giubertoni A, Bellan M, Cumitini L, Patti G Rev Cardiovasc Med. 2025; 26(1):25914.

PMID: 39867169 PMC: 11759969. DOI: 10.31083/RCM25914.

Towards a Better Prognosis in Patients with Systemic Sclerosis-Related Pulmonary Arterial Hypertension: Recent Developments and Perspectives.

Boutel M, Dara A, Arvanitaki A, Deuteraiou C, Mytilinaiou M, Dimitroulas T J Clin Med. 2024; 13(19).

PMID: 39407897 PMC: 11477739. DOI: 10.3390/jcm13195834.

Use of exercise tests in screening for pulmonary arterial hypertension in systemic sclerosis: A systematic literature review.

Madigan S, Proudman S, Schembri D, Davies H, Adams R J Scleroderma Relat Disord. 2024; 9(1):50-58.

PMID: 38333530 PMC: 10848927. DOI: 10.1177/23971983231199148.

The Early Detection of Pulmonary Hypertension.

Ley L, Grimminger F, Richter M, Tello K, Ghofrani A, Bandorski D Dtsch Arztebl Int. 2023; 120(48):823-830.

PMID: 37882345 PMC: 10853922. DOI: 10.3238/arztebl.m2023.0222.

The Current Role of Cardiopulmonary Exercise Test in the Diagnosis and Management of Pulmonary Hypertension.

Pezzuto B, Agostoni P J Clin Med. 2023; 12(17).

PMID: 37685532 PMC: 10487723. DOI: 10.3390/jcm12175465.

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