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Determining the necessity for right heart catheterization in pulmonary hypertension associated with connective tissue diseases assessed by echocardiography
Author(s) -
Choi Joon Hyouk,
Joo SeungJae,
Kim Jinseok
Publication year - 2016
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/1756-185x.12769
Subject(s) - medicine , cardiology , pulmonary hypertension , ventricular outflow tract , doppler echocardiography , diastole , cardiac catheterization , systemic scleroderma , ventricular pressure , connective tissue disease , tissue doppler echocardiography , blood pressure , hemodynamics , dermatomyositis , autoimmune disease , disease , diastolic function
Aim The prognosis of pulmonary hypertension ( PH ) in systemic sclerosis ( SSC ) and in systemic lupus erythematosus ( SLE ) is different. According to the guidelines, right heart catheterization ( RHC ) is necessary in pulmonary arterial hypertension ( PAH ) associated with connective tissue diseases ( CTD ). However, there is little supporting evidence. Therefore, we attempted to determine the necessity for RHC and the causes of differences in prognosis of PH by comparing SSC to SLE . Methods The inclusion criteria were all patients with SSC or SLE with exertional dyspnea. Echocardiography and carotid Doppler ultrasound were performed. Results Twenty‐three patients with SSC and 23 with SLE participated in this study. There was no difference in the right ventricular systolic pressure ( RVSP ) between SSC and SLE (33.0 mmHg, range 25.3–41.7 mmHg vs . 32.4 mmHg, range 27.0–37.7 mmHg; P = 0.835). In multiple linear regression analysis, the ratio of peak tricuspid regurgitant velocity to right ventricular outflow tract time‐velocity integral, which represents pulmonary vascular resistance ( PVR ), was correlated with RVSP in SSC ( r 2 = 0.928, β = 0.362, P = 0.003), and the independent predictor of increased RVSP was the ratio of early diastolic transmitral filling velocity to early diastolic septal mitral annular velocity, which represents diastolic dysfunction in SLE ( R 2 = 0.806, β = 0.803, P = 0.023). Conclusions PVR was an important cause of PH in SSC . Left ventricular dysfunction was an important cause of PH in SLE . Thus, these findings demonstrate the necessity for RHC and differences in prognosis of PH in CTD .