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Screening pulmonary hypertension in systemic sclerosis using cardiopulmonary exercise test
Session:
Posters (Sessão 1 - Écran 3) - Doença Cardiovascular em Populações Especiais 1
Speaker:
Maria Isilda Oliveira
Congress:
CPC 2022
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.12 Autoimmune/Chronic Inflammatory Disorders and Heart Disease
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Maria Isilda Oliveira; Inês Furtado; Luísa Carvalho; Fabienne Gonçalves; Abílio Reis; Mário Santos
Abstract
<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Introduction</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Times New Roman",serif">Pulmonary arterial hypertension (PAH) is one of the most severe complication of systemic sclerosis (SSc). Its early detection and treatment improve prognosis. We aimed to study the diagnostic performance of cardiopulmonary exercise testing (CPET) for PAH screening in SSc patients.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Methods</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Times New Roman",serif">We retrospectively reviewed clinical data from SSc patients from February 2019 to November 2021. SSc patients were considered not having PAH if they present (1) normal invasive hemodynamics or, in the absence of invasive hemodynamics, if (2) patients presented a normal resting echocardiogram, normal NT-proBNP and FVC/DLCO ratio ≤ 1.6. Informed by previous studies, our CPET variables of interest were VO2 peak % predicted, VO2 peak L/min/Kg, VE/VCO2 slope and peak PetCO2. For minimizing the false-positive results, we studied the thresholds for each parameter to have a sensitivity of 100%.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Results</span></strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Times New Roman",serif">Of 34 SSc patients with suspected PAH (61±13 years; 94% female), 5 (15%) had the diagnosis of PAH (mean PAP 35±11 mmHg; PVR 4.1±1.8 WU). Of patients without PAH who underwent right heart catheterization (n=15), 27% had group 2 pulmonary hypertension. Patients with PAH had lower VO2peak (14.4±1.2 vs 17.8±3.4 L/min/Kg, p=0.04), predicted VO2peak (74±10 vs 83±18 %, p=0.04) and peak PetCO2 (26.6±4.6 vs 32.9±5.0 mmHg; p=0.01), and increased VE/VCO2 slope (40.7±7.6 vs 34.3±6.0; p=0.04). For these variables, the area under the curve for detecting PAH were 0.84, 0.68, 0.84 and 0.77, respectively. With a sensitivity of 100%, the threshold and specificity (S) for each parameter were: VO2peak < 13 L/min/Kg (S-7%), predicted VO2peak < 59% (S-7%), peak PetCO2 < 22 (S-4%) and VE/VCO2 slope > 32 (S-41%).</span></span></span></p> <p> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Conclusion</span></strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Times New Roman",serif">In patients with SSc, CPET parameters of maximal exercise capacity and ventilatory efficiency are associated with the presence of PAH. Peak VO2 and PetCO2 are the best discriminator of the presence of PAH. Despite the reduction in specificity for attaining a sensitivity of 100%, our data suggests the utility of CPET to reduce unnecessary right heart catheterization in SSc patients.</span></span></span></p>
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