Screening for pulmonary arterial hypertension in systemic sclerosis: A systematic literature review.

Cosimo Bruni, Giacomo De Luca, Maria Grazia Lazzaroni, Elisabetta Zanatta, Gemma Lepri, Paolo Airò, Lorenzo Dagna, Andrea Doria, Marco Matucci-Cerinic

Research output: Contribution to journalReview articlepeer-review


Pulmonary arterial hypertension (PAH) carries a high morbidity and mortality burden in Systemic Sclerosis (SSc). Therefore, PAH screening and early detection are pivotal. A systematic literature review (SLR) to search for all screening tools and modalities for SSc-PAH was performed in reference to right heart catheterization as diagnostic gold standard. Papers from 2 previously published SLRs and derived from a systematic search on Pubmed, EMBASE, Web of Science for papers published from 03/10/2017 to 31/12/2018 were manually included. A total of 199 papers were reviewed and 32 were extracted, with a low bias risk according to QUADAS2. Echocardiography, pulmonary function tests, clinical features and serum biomarkers were the most frequently tools used for screening, with different parameters combined in a variable fashion, as single item or as part of composite algorithms. Among the composite algorithms, the DETECT score, ESC/ERS 2009 or 2015 guidelines, ASIG and ITINER-air algorithms were the most commonly used in a wide range of patients. In different cohorts, DETECT and ASIG showed higher sensitivity and negative predictive value than ESC/ERS 2009. In conclusion, the literature shows echocardiography as the leading screening tool for SSc-PAH. In particular, systolic pulmonary arterial pressure (sPAP) and tricuspid regurgitation velocity (TRV), both as single items or part of composite algorithms, including also serum biomarkers, clinical and functional items, are the most frequent parameters evaluated.

Original languageEnglish
Pages (from-to)17-25
Number of pages9
JournalEuropean Journal of Internal Medicine
Publication statusPublished - Aug 2020


  • Algorithms
  • Pulmonary arterial hypertension
  • Screening
  • Systemic sclerosis

ASJC Scopus subject areas

  • Internal Medicine


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