H2 FPEF score predicts atherosclerosis presence in patients with systemic connective tissue disease

In systemic sclerosis TAPSE/sPAP ratio can be used in addition to the DETECT algorithm for pulmonary arterial hypertension diagnosis

OBJECTIVE

Early detection of pulmonary arterial hypertension (PAH) is crucial to improve patient outcomes. The aim of this study was to compare the positive predictive value (PPV) between the echocardiography-derived tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (TAPSE/sPAP) ratio and the DETECT algorithm for PAH screening in a cohort of systemic sclerosis (SSc) patients.

METHODS

51 SSc patients were screened for PAH using DETECT algorithm and echocardiography.

RESULTS

Echocardiography was recommended by the DETECT algorithm step 1 in 34 patients (66.7%). Right heart catheterization (RHC) was recommended by the DETECT algorithm step 2 in 16 patients (31.4%). PAH was confirmed by RHC in 5 patients. DETECT algorithm positive predictive value (PPV) was 31.3%.TAPSE/sPAP ratio was higher in SSc patients not referred for RHC than in SSc patients referred for RHC according to DETECT algorithm step 2 [0.83 (0.35-1.40) mm/mmHg vs 0.74 (0.12-1.09) mm/mmHg, p < 0.05]. Using a cut-off of 0.60 mm/mmHg, 8 (15.7%) SSc patients had a TAPSE/sPAP ratio ≤0.60 mm/mmHg. PAH was confirmed by RHC in 5 patients. PPV of TAPSE/sPAP was 62.5%.In multiple regression analysis, TAPSE/sPAP was associated with age (β coefficient = -0.348 [95% CI, -0.011 to -0.003]; p < 0.01), DETECT algorithm step 1 (β coefficient = 1.023 [95% CI, 0.006-0.024]; p < 0.01) and DETECT algorithm step 2 (β coefficient = -1.758 [95% CI, -0.059 to -0.021]; p < 0.0001).

CONCLUSION

In SSc patients with a DETECT algorithm step 2 total score >35 the TAPSE/sPAP ratio can be used to further select patients requiring RHC to confirm PAH diagnosis.

H2 FPEF score predicts atherosclerosis presence in patients with systemic connective tissue disease

BACKGROUND

Cardiovascular diseases are common cause of morbidity and mortality in patients with systemic connective tissue diseases (SCTD) due to accelerated atherosclerosis which couldn't be explained by traditional risk factors (CVDRF).

HYPOTHESIS

We hypothesized that recently developed score predicting probability of heart failure with preserved ejection fraction (H₂ FPEF), as well as a measure of right ventricular-pulmonary vasculature coupling [tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) ratio], are predictive of atherosclerosis in SCTD.

METHODS

203 patients (178 females) diagnosed with SCTD underwent standard and stress-echocardiography (SE) with TAPSE/PASP and left ventricular (LV) diastolic filling pressure (E/e') measurements, carotid ultrasound and computed tomographic coronary angiography. Patients who were SE positive for ischemia underwent coronary angiography (34/203). The H₂ FPEF score was calculated according to age, body mass index, presence of atrial fibrillation, ≥2 antihypertensives, E/e' and PASP.

RESULTS

Mean LV ejection fraction was 66.3 ± 7.1%. Atherosclerosis was present in 150/203 patients according to: 1) intima-media thickness>0.9 mm; and 2) Agatstone score > 300 or Syntax score ≥ 1. On binary logistic regression analysis, including CVDRF prevalence, echocardiographic parameters and H₂ FPEF score, only H₂ FPEF score remained significant for the prediction of atherosclerosis presence (χ² = 19.3, HR 2.6, CI 1.5-4.3, p < 0.001), and resting TAPSE/PASP for the prediction of a SE positive for ischemia (χ² = 10.4, HR 0.01, CI = 0.01-0.22, p = 0.004). On ROC analysis, the optimal threshold value for identifying patients with atherosclerosis was a H₂ FPEF score ≥2 (Sn 60.4%, Sp 69.4%, area 0.67, SE = 0.05, p < 0.001).

CONCLUSIONS

H₂ FPEF score and resting TAPSE/PASP demonstrated clinical value for an atherosclerosis diagnosis in patients diagnosed with SCTD.