Quinn et al evaluated exercise echocardiography in patients with systemic sclerosis. The presence of a positive echocardiogram can identify a group of patients who may develop pulmonary hypertension. The authors are from MedStar Georgetown University Hospital in Washington DC.
Patient selection: systemic sclerosis with any of the following - dyspnea on exertion, DLco less than 60% of predicted, FVC less than 60% of predicted, FVC percent to DLco percent ratio > 1.6 or resting right ventricular systolic pressure from 31 to 49 mm Hg.
Pulmonary hypertension in systemic sclerosis:
(1) pulmonary arterial hypertension
(2) pulmonary venous hypertension
(3) pulmonary hypertension associated with interstitial lung disease
Criteria for pulmonary arterial hypertension - both of the following:
(1) mean pulmonary artery pressure >= 25 mm Hg AND
(2) pulmonary artery wedge pressure < 15 mm Hg
Examination: exercise echocardiography
Criteria for a positive exercise echocardiogram: increase in right ventricular systolic pressure >= 20 mm Hg during exercise
increase in right ventricular systolic pressure =
= (right ventricular systolic pressure with exercise) - (right ventricular systolic pressure at rest)
Exercise Echocardiography
|
Percent Developing Pulmonary Hypertension
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negative
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7%
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positive
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23% (over a mean 4-year follow-up period)
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Performance:
• The method is somewhat sensitive but not specific.