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Expert consensus for performing right heart catheterisation for suspected pulmonary arterial hypertension in systemic sclerosis: a Delphi consensus study with cluster analysis
  1. Jérôme Avouac1,
  2. Dörte Huscher2,
  3. Daniel E Furst3,
  4. Christian F Opitz4,
  5. Oliver Distler5,
  6. Yannick Allanore1,
  7. for the EPOSS group
  1. 1Sorbonne Paris Cité, Rheumatology A Department, Cochin Hospital, Paris Descartes University, Paris, France
  2. 2Department of Epidemiology Group, German Rheumatism Research Centre (DRFZ), a Leibniz Institute, Berlin, Germany
  3. 3Division of Rheumatology, Department of Medicine, David Geffen School at UCLA, Los Angeles, California, USA
  4. 4Klinik für Innere Medizin, DRK-Kliniken Berlin Köpernick, Berlin, Germany
  5. 5Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
  1. Correspondence to Dr J Avouac, Sorbonne Paris Cité, Service de rhumatologie A, Hôpital Cochin, Paris Descartes University, 27 rue du faubourg Saint Jacques, Paris 75014, France; jerome.avouac{at}


Objective To establish an expert consensus on which criteria are the most appropriate in clinical practice to refer patients with systemic sclerosis (SSc) for right heart catheterisation (RHC) when pulmonary hypertension (PH) is suspected.

Methods A three stage internet based Delphi consensus exercise involving worldwide PH experts was designed. In the first stage, a comprehensive list of domains and items combining evidence based indications and expert opinions were obtained. In the second and third stages, experts were asked to rate each item selected in the list. After each of stages 2 and 3, the number of items and criteria were reduced according to a cluster analysis.

Results A literature search and the opinions of 47 experts participating in Delphi stage 1 provided a list of seven domains containing 142 criteria. After stages 2 and 3, these domains and tools were reduced to three domains containing eight tools: clinical (progressive dyspnoea over the past 3 months, unexplained dyspnoea, worsening of WHO dyspnoea functional class, any finding on physical examination suggestive of elevated right heart pressures and any sign of right heart failure), echocardiography (systolic pulmonary artery pressure >45 mm Hg and right ventricle dilation) and pulmonary function tests (diffusion lung capacity for carbon monoxide <50% without pulmonary fibrosis).

Conclusions Among experts in pulmonary arterial hypertension–SSc, a core set of criteria for clinical practice to refer SSc patients for RHC has been defined by Delphi consensus methods. Although these indications are recommended by this expert group to be used as an interim tool, it will be necessary to formally validate the present tools in further studies.

  • Systemic Sclerosis
  • Outcomes research
  • Multidisciplinary team-care

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