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Submaximal Heart and Pulmonary Evaluation: A Novel Noninvasive Test to Identify Pulmonary Hypertension in Patients With Systemic Sclerosis
Author(s) -
Bernstein Elana J.,
Mandl Lisa A.,
Gordon Jessica K.,
Spiera Robert F.,
Horn Evelyn M.
Publication year - 2013
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.22051
Subject(s) - medicine , pulmonary hypertension , cardiology , pulmonary artery , scleroderma (fungus) , retrospective cohort study , right heart catheterization , gold standard (test) , cohort , predictive value , pathology , inoculation
Objective Pulmonary hypertension (PH) is a leading cause of death in patients with systemic sclerosis (SSc; scleroderma). Although right‐sided heart catheterization (RHC) is the gold standard for diagnosing PH, it is an invasive test with associated risks. The submaximal heart and pulmonary evaluation (step test) is a noninvasive, submaximal stress test that could be used to identify patients with PH. The purpose of this study is to assess the correlation between change in end tidal carbon dioxide (ΔP ETCO2 ) from rest to end‐exercise on the step test and mean pulmonary artery pressure (mPAP) on RHC in SSc patients. Methods This is a retrospective cohort study of patients with limited or diffuse cutaneous SSc who were evaluated in an academic cardiology practice between November 2007 and November 2011 and underwent a step test and RHC. Statistical analysis was performed using Spearman's correlation test and multivariable linear regression. Results A total of 679 charts were reviewed. Nineteen SSc patients who underwent a step test and RHC were included. ΔP ETCO2 was negatively correlated with mPAP (r = −0.82, P < 0.0001). In a multivariable linear regression model evaluating the relationship between ΔP ETCO2 and mPAP, controlling for age, sex, and time between and order of step test and RHC, ΔP ETCO2 remained the only variable statistically significantly associated with mPAP ( P < 0.001). The step test had a sensitivity of 100%, specificity of 75%, positive predictive value of 93.8%, and negative predictive value of 100% for the diagnosis of PH. Conclusion ΔP ETCO2 on the step test has a strong, statistically significant negative correlation with mPAP on RHC.