Cardiopulmonary exercise testing in a combined screening approach to individuate pulmonary arterial hypertension in systemic sclerosis: Rheumatology (United Kingdom)

A. Santaniello, R. Casella, M. Vicenzi, I. Rota, G. Montanelli, M. De Santis, C. Bellocchi, F. Lombardi, L. Beretta

Research output: Contribution to journalArticlepeer-review

Abstract

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. © 2019 The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology.
Original languageEnglish
Pages (from-to)1581-1586
Number of pages6
JournalRheumatology
Volume59
Issue number7
DOIs
Publication statusPublished - 2020

Keywords

  • cardiopulmonary exercise testing
  • pulmonary arterial hypertension
  • screening
  • systemic sclerosis

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