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SAT0225 Screening for Pulmonary Arterial Hypertension in Systemic Sclerosis Patients: Single Center Real-Life Performance of The Detect Algorithm
  1. F. De Nard1,
  2. V. Codullo1,
  3. V. Grosso1,
  4. A. Gallarati1,
  5. S. Ghio2,
  6. L. Scelsi2,
  7. C. Raineri2,
  8. R. Caporali1,
  9. C. Montecucco1
  1. 1Rheumatology Unit
  2. 2Cardiology Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy

Abstract

Background A new algorithm for early detection of PAH in Systemic Sclerosis (SSc) patients has been recently developed (1). However, the cost-effectiveness of this strategy has not yet been defined in a real-life setting.

Objectives The aim of this study was to compare two methods of PAH screening among SSc patients for the referral to invasive tests (right heart catheterization (RHC)) in a single PH referral center.

Methods Patients with SSc according to the ACR/EULAR 2013 classification criteria were enrolled in the study and prospectively followed in a Scleroderma Unit of a University Hospital which is also a PH referral center between Jan 2015 and Jan 2016 with at least 6-monthly visits. According to the ESC/ERS 2015 guidelines (2), annual screening with echocardiography, DLCO, ECG and serum biomarkers (including urate and NT-proBNP) was performed. Patients satisfying the two-steps DETECT score and/or with echocardiographically estimated Pulmonary Arterial Systolic Pressure (PASP) ≥45 mmHg or between 35–45 mmHg with unexplained dyspnea (3) were referred to an expert cardiologist to undergo RHC.

Results Three-hundred patients with a diagnosis of SSc were screened and 39 patients (13%) met the criteria for the application of the DETECT algorithm (disease duration >3 years, DLCO <60%). The male:female ratio was 1:12; 16 patients (41%) were positive for anticentromere antibodies; 14 patients showed cutaneous teleangectasias (26%); 33 patients (85%) were classified as limited SSc, 4 (10%) as diffuse SSc and 2 as SSc without skin involvement (5%). For 2 of them (5%), STEP 1 score was not calculated due to missing serum biomarkers. Among the remaining 37 patients, 2 (5%) had a STEP 1 score <300; and 35 (95%) showed a STEP 1 score ≥300. Among the latter, for 11 (31%) echocardiographic measures for the calculation of the STEP 2 score could not be derived. In 7/24 (29%) the STEP 2 score was <35 while in 17/24 (71%) ≥35, thus needing referral to RHC according to the DETECT algorithm. In the same 39-patients group, 12 (31%) satisfied the ItinerAir criteria for RHC (p=0,0019, chi-squared).

Conclusions Our results indicate that the feasibility in clinical practice of both PAH screening methods strongly depends on the performance of a correct echocardiographic screening, with a complete assessment and quantification of right heart parameters, which often lacks in outpatient practice. In addition, applying the DETECT algorithm, a larger number of patients should be sent to RHC than those identified by solely echocardiographic parameters. Further observational studies are needed to define the real-life sensivity and cost-effectiveness of this new algorithm.

  1. Coghlan JG et al, Ann Rheum Dis 2014.

  2. Galiè N et al, Eur Respir J 2015.

  3. Hachulla E et al, Arthritis Rheum 2005.

Disclosure of Interest None declared

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