Evaluation of pulmonary artery stiffness in patients with systemic sclerosis
Year 2024,
Volume: 37 Issue: 1, 11 - 17, 28.01.2024
Dursun Akaslan
,
Murat Demirci
Abstract
Objective: The study aims to investigate the use of pulmonary artery stiffness (PAS) parameter in early diagnosis of systemic sclerosis
(SSc) and pulmonary hypertension in SSc patients.
Patients and Methods: The study involved 102 SSc patients and 45 control group patients, who underwent transthoracic
echocardiographic evaluations.
Results: Pulmonary artery stiffness was measured as 25.7±7.6 (Hz/msn) in the SSc cases and 13.7 ±1.6 (Hz/msn) in the healthy
subjects (P< 0.001). TAPSE/sPAP ratio, which we used as an indicator of RV-PA coupling, was calculated as 0.65+0.28 in SSc cases and
1.12+0.33 in the control group (P<0.001).
When we evaluated PAS values of subgroups PAS was significantly higher in SScPH(-) patients without pulmonary hypertension than
control subjects (respectively; 21.67 ± 3.9; 13.7 ± 1.6, P<0.001). The relationship of PAS with the parameters in which pulmonary
hypertension and right ventricular functions were evaluated, there was a positive correlation with sPAP( r: – 0.396, P <0.001), while a
negative correlation was observed with TAPSE/sPAP (r: 0.456, P<0.001).
Conclusion: We observed higher PAS values in SScPH(-) patients compared to the control group and found a positive correlation
between the increase in PAS and sPAP and a negative correlation between them and TAPSE/sPAP.
References
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outcome in systemic sclerosis-associated pulmonary arterial
hypertension: application of a registry approach. Ann Rheum
Dis 2003; 62:1088-93. doi: 10.1136/ard.62.11.1088
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Document Group. 2022 ESC/ERS Guidelines for the diagnosis
and treatment of pulmonary hypertension. Eur Heart J 2022;
43:3618-731. doi: 10.1093/eurheartj/ehac237
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detection of pulmonary arterial hypertension in systemic
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9. doi: 10.1136/annrheumdis-2013-203301.
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Rangarajan V, Matiasz R, Freed BH et al. Cardiac
complications of systemic sclerosis and management: recent
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BOR.000.000.0000000439.
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Brown Z, Proudman S, Morrisroe K, et al. Screening for the
early detection of pulmonary arterial hypertension in patients
with systemic sclerosis: A systematic review and meta-analysis
of long-term outcomes. Semin Arthritis Rheum 2021;51:495-
512. doi:10.1016/j.semarthrit.2021.03.011
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Horvat D, Zlibut A, Orzan RI, et al. Aging influences
pulmonary artery flow and stiffness in healthy individuals:
non-invasive assessment using cardiac MRI. Clin Radiol
2021;76:161.e19-161.e28. doi:10.1016/j.crad.2020.09.021
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van den Hoogen F, Khanna D, Fransen J, et al. 2013
classification criteria for systemic sclerosis: an American
college of rheumatology/European league against rheumatism
collaborative initiative. Ann Rheum Dis 2013;72:1747-55.
doi:10.1136/annrheumdis-2013-204424
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Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the
echocardiographic assessment of the right heart in adults:
a report from the American Society of Echocardiograph
endorsed by the European Association of Echocardiography,
a registered branch of the European Society of Cardiology,
and the Canadian Society of Echocardiography. J Am
Soc Echocardiogr 2010;23:685-788. doi:10.1016/j.
echo.2010.05.010
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Colalillo A, Grimaldi MC, Vaiarello V, et al. In systemic
sclerosis, the TAPSE/sPAP ratio can be used in addition to
the DETECT algorithm for pulmonary arterial hypertension
diagnosis. Rheumatology (Oxford) 2022;61:2450-56.
doi:10.1093/rheumatology/keab748
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Görgülü S, Eren M, Yildirim A, et al. A new echocardiographic
approach in assessing pulmonary vascular bed in patients with
congenital heart disease: pulmonary artery stiffness. Anadolu
Kardiyol Derg 2003;3:92-97.
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Koh ET, Lee P, Gladman DD, Abu-Shakra M. Pulmonary
hypertension in systemic sclerosis: an analysis of 17
patients. Br J Rheumatol 1996;35:989-93. doi:10.1093/
rheumatology/35.10.989
-
Belin RJ, Varga J, Collins JD, Freed BH. Right ventricular
cardiomyopathy in systemic sclerosis. Rheumatology (Oxford)
2017;56:1045-47. doi:10.1093/rheumatology/kew494
-
Demirci M, Ozben B, Sunbul M, et al. The evaluation of right
ventricle dyssynchrony by speckle tracking echocardiography
in systemic sclerosis patients. J Clin Ultrasound 2021;49:895-
902. doi:10.1002/jcu.23041
-
Chemla D, Weatherald J, Lau EMT, et al. Clinical and
hemodynamic correlates of pulmonary arterial stiffness
in incident, untreated patients with idiopathic pulmonary
arterial hypertension. Chest 2018;154:882-92. doi:10.1016/j.
chest.2018.06.015
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Kang KW, Chang HJ, Kim YJ, et al. Cardiac magnetic
resonance imaging-derived pulmonary artery distensibility
index correlates with pulmonary artery stiffness and predicts
functional capacity in patients with pulmonary arterial
hypertension. Circ J 2011;75:2244-51. doi:10.1253/circj.cj-10-
1310
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Yaşar S, Unlu M, Görmel S, et al. Evaluation of the relationship
between pulmonary artery stiffness and right ventricular
function in patients with Behçet’s disease using transthoracic
echocardiography. Authorea 2021: 2232-36. doi 10.22541/
au.163615.894.48445737/v1
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Ozkececi G, Ulasli SS, Akci O, et al. Assessment of pulmonary
arterial stiffness in obstructive sleep apnea. Int J Cardiovasc
Imaging 2016;32:799-805. doi:10.1007/s10554.016.0841-0
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Baysal SS, Has M. Evaluation of pulmonary artery stiffness in
newly diagnosed adult patients with asthma. Echocardiography
2019;36:870-76. doi:10.1111/echo.14309
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Abacioglu OO, Gulumsek E, Sumbul H, Kaplan M, Yavuz
F. Increased pulmonary arterial stiffness and impaired right
ventricle-pulmonary artery coupling in PCOS. Arq Bras
Cardiol 2021;116:806-11. doi:10.36660/abc.20190762
-
Öz A, Çınar T, Taş E, Çağan Efe S, Ayça B, Karabağ T.
Assessment of pulmonary arterial stiffness in patients with
cirrhosis: A prospective cohort study. Echocardiography
2021;38:57-63. doi:10.1111/echo.14935
-
Yenerçağ M, Arslan U, Dereli S, Çoksevim M, Doğduş M,
Kaya A. Effects of angiotensin receptor neprilysin inhibition
on pulmonary arterial stiffness in heart failure with reduced
ejection fraction. Int J Cardiovasc Imaging 2021;37:165-73.
doi:10.1007/s10554.020.01973-8
-
Duman D, Masatlıoğlu S, Demirtunç R,Karadağ B Increased
pulmonary artery stiffness and its relation to right ventricular
function in patients with systemic lupus erythematosus. Turk
Kardiyoloji Dernegi Arsivi 2008; 36,2:82-9.
-
Cerik IB, Meric M, Gulel O, et al. Echocardiographic
assessment of pulmonary arterial stiffness in human
immunodeficiency virus-infected patients. Echocardiography
2019;36:1123-31. doi:10.1111/echo.14349
-
Hoffmann-Vold AM, Fretheim H, Midtvedt Q, et al.
Frequencies of borderline pulmonary hypertension before
and after the DETECT algorithm: results from a prospective
systemic sclerosis cohort. Rheumatology (Oxford)
2018;57:480-87. doi:10.1093/rheumatology/kex435
-
Colalillo A, Hoffmann-Vold AM, Pellicano C, et al.
The role of TAPSE/sPAP ratio in predicting pulmonary
hypertension and mortality in the systemic sclerosis EUSTAR
cohort. Autoimmun Rev 2023;22:113-19. doi:10.1016/j.
autrev.2023.103290
-
Baptista R, Serra S, Martins R, et al. Exercise echocardiography
for the assessment of pulmonary hypertension in systemic
sclerosis: a systematic review. Arthritis Res Ther 2016;18:153.
doi:10.1186/s13075.016.1051-9
Year 2024,
Volume: 37 Issue: 1, 11 - 17, 28.01.2024
Dursun Akaslan
,
Murat Demirci
References
-
Mukerjee D, George DS, Coleiro B, et al. Prevalence and
outcome in systemic sclerosis-associated pulmonary arterial
hypertension: application of a registry approach. Ann Rheum
Dis 2003; 62:1088-93. doi: 10.1136/ard.62.11.1088
-
Humbert M, Kovacs G, Hoeper M, et al. ESC/ERS Scientific
Document Group. 2022 ESC/ERS Guidelines for the diagnosis
and treatment of pulmonary hypertension. Eur Heart J 2022;
43:3618-731. doi: 10.1093/eurheartj/ehac237
-
Coghlan JG, Denton CP, Grünig E, et al. Evidence-based
detection of pulmonary arterial hypertension in systemic
sclerosis: the DETECT study. Ann Rheum Dis 2014; 73:1340-
9. doi: 10.1136/annrheumdis-2013-203301.
-
Rangarajan V, Matiasz R, Freed BH et al. Cardiac
complications of systemic sclerosis and management: recent
progress. Curr Opin Rheumatol 2017; 9: 574–84. doi:10.1097/
BOR.000.000.0000000439.
-
Brown Z, Proudman S, Morrisroe K, et al. Screening for the
early detection of pulmonary arterial hypertension in patients
with systemic sclerosis: A systematic review and meta-analysis
of long-term outcomes. Semin Arthritis Rheum 2021;51:495-
512. doi:10.1016/j.semarthrit.2021.03.011
-
Horvat D, Zlibut A, Orzan RI, et al. Aging influences
pulmonary artery flow and stiffness in healthy individuals:
non-invasive assessment using cardiac MRI. Clin Radiol
2021;76:161.e19-161.e28. doi:10.1016/j.crad.2020.09.021
-
van den Hoogen F, Khanna D, Fransen J, et al. 2013
classification criteria for systemic sclerosis: an American
college of rheumatology/European league against rheumatism
collaborative initiative. Ann Rheum Dis 2013;72:1747-55.
doi:10.1136/annrheumdis-2013-204424
-
Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the
echocardiographic assessment of the right heart in adults:
a report from the American Society of Echocardiograph
endorsed by the European Association of Echocardiography,
a registered branch of the European Society of Cardiology,
and the Canadian Society of Echocardiography. J Am
Soc Echocardiogr 2010;23:685-788. doi:10.1016/j.
echo.2010.05.010
-
Colalillo A, Grimaldi MC, Vaiarello V, et al. In systemic
sclerosis, the TAPSE/sPAP ratio can be used in addition to
the DETECT algorithm for pulmonary arterial hypertension
diagnosis. Rheumatology (Oxford) 2022;61:2450-56.
doi:10.1093/rheumatology/keab748
-
Görgülü S, Eren M, Yildirim A, et al. A new echocardiographic
approach in assessing pulmonary vascular bed in patients with
congenital heart disease: pulmonary artery stiffness. Anadolu
Kardiyol Derg 2003;3:92-97.
-
Koh ET, Lee P, Gladman DD, Abu-Shakra M. Pulmonary
hypertension in systemic sclerosis: an analysis of 17
patients. Br J Rheumatol 1996;35:989-93. doi:10.1093/
rheumatology/35.10.989
-
Belin RJ, Varga J, Collins JD, Freed BH. Right ventricular
cardiomyopathy in systemic sclerosis. Rheumatology (Oxford)
2017;56:1045-47. doi:10.1093/rheumatology/kew494
-
Demirci M, Ozben B, Sunbul M, et al. The evaluation of right
ventricle dyssynchrony by speckle tracking echocardiography
in systemic sclerosis patients. J Clin Ultrasound 2021;49:895-
902. doi:10.1002/jcu.23041
-
Chemla D, Weatherald J, Lau EMT, et al. Clinical and
hemodynamic correlates of pulmonary arterial stiffness
in incident, untreated patients with idiopathic pulmonary
arterial hypertension. Chest 2018;154:882-92. doi:10.1016/j.
chest.2018.06.015
-
Kang KW, Chang HJ, Kim YJ, et al. Cardiac magnetic
resonance imaging-derived pulmonary artery distensibility
index correlates with pulmonary artery stiffness and predicts
functional capacity in patients with pulmonary arterial
hypertension. Circ J 2011;75:2244-51. doi:10.1253/circj.cj-10-
1310
-
Yaşar S, Unlu M, Görmel S, et al. Evaluation of the relationship
between pulmonary artery stiffness and right ventricular
function in patients with Behçet’s disease using transthoracic
echocardiography. Authorea 2021: 2232-36. doi 10.22541/
au.163615.894.48445737/v1
-
Ozkececi G, Ulasli SS, Akci O, et al. Assessment of pulmonary
arterial stiffness in obstructive sleep apnea. Int J Cardiovasc
Imaging 2016;32:799-805. doi:10.1007/s10554.016.0841-0
-
Baysal SS, Has M. Evaluation of pulmonary artery stiffness in
newly diagnosed adult patients with asthma. Echocardiography
2019;36:870-76. doi:10.1111/echo.14309
-
Abacioglu OO, Gulumsek E, Sumbul H, Kaplan M, Yavuz
F. Increased pulmonary arterial stiffness and impaired right
ventricle-pulmonary artery coupling in PCOS. Arq Bras
Cardiol 2021;116:806-11. doi:10.36660/abc.20190762
-
Öz A, Çınar T, Taş E, Çağan Efe S, Ayça B, Karabağ T.
Assessment of pulmonary arterial stiffness in patients with
cirrhosis: A prospective cohort study. Echocardiography
2021;38:57-63. doi:10.1111/echo.14935
-
Yenerçağ M, Arslan U, Dereli S, Çoksevim M, Doğduş M,
Kaya A. Effects of angiotensin receptor neprilysin inhibition
on pulmonary arterial stiffness in heart failure with reduced
ejection fraction. Int J Cardiovasc Imaging 2021;37:165-73.
doi:10.1007/s10554.020.01973-8
-
Duman D, Masatlıoğlu S, Demirtunç R,Karadağ B Increased
pulmonary artery stiffness and its relation to right ventricular
function in patients with systemic lupus erythematosus. Turk
Kardiyoloji Dernegi Arsivi 2008; 36,2:82-9.
-
Cerik IB, Meric M, Gulel O, et al. Echocardiographic
assessment of pulmonary arterial stiffness in human
immunodeficiency virus-infected patients. Echocardiography
2019;36:1123-31. doi:10.1111/echo.14349
-
Hoffmann-Vold AM, Fretheim H, Midtvedt Q, et al.
Frequencies of borderline pulmonary hypertension before
and after the DETECT algorithm: results from a prospective
systemic sclerosis cohort. Rheumatology (Oxford)
2018;57:480-87. doi:10.1093/rheumatology/kex435
-
Colalillo A, Hoffmann-Vold AM, Pellicano C, et al.
The role of TAPSE/sPAP ratio in predicting pulmonary
hypertension and mortality in the systemic sclerosis EUSTAR
cohort. Autoimmun Rev 2023;22:113-19. doi:10.1016/j.
autrev.2023.103290
-
Baptista R, Serra S, Martins R, et al. Exercise echocardiography
for the assessment of pulmonary hypertension in systemic
sclerosis: a systematic review. Arthritis Res Ther 2016;18:153.
doi:10.1186/s13075.016.1051-9