medwireNews: Measures of right ventricular (RV) function could provide “crucial information” to predict which patients with systemic sclerosis (SSc) are at high risk for poor outcomes, researchers report in Arthritis Research & Therapy.
The team from Heidelberg University Hospital in Germany, led by Christina Eichstaedt, studied data from 225 people with SSc (mean age 58.1 years, 81.3% women) who underwent routine screening for pulmonary hypertension (PH) between 2008 and 2020.
In all, 66.2% of the cohort had no signs of pulmonary vascular disease (PVD) at baseline, while 10.6% had manifest PH, defined as elevated mean pulmonary artery pressure (mPAP; ≥25 mmHg) and pulmonary vascular resistance (PVR; ≥3 Wood Units), and the remaining 23.1% had mildly elevated mPAP and PVR, suggesting early signs of PVD.
Eichstaedt and colleagues report that 35 patients died during a mean follow-up period of 3.2 years, with the most common cause of death being PH or pulmonary arterial hypertension (51.4%), followed by cancer (14.3%), pulmonary fibrosis (8.6%), and left heart disease (8.6%).
Kaplan–Meier survival analysis showed that impaired RV function according to various echocardiographic measures was significantly associated with worse survival in the cohort. These measures included tricuspid annular plane systolic excursion (TAPSE) at rest of less than 18 mm and TAPSE/systolic (s)PAP ratio of 0.6 mL/mmHg or lower.
Moreover, several invasively determined measures of RV function – including PVR of at least 2 Wood Units and RV pulmonary vascular reserve during exercise of at least 3 mmHg/L per min – were associated with increased mortality risk.
The team then carried out a multivariable analysis to identify predictors of survival in the SSc cohort, finding that a TAPSE/sPAP ratio of 0.6 mL/mmHg or lower and diffusion capacity for carbon monoxide of 65% predicted or lower were significantly and independently associated with worse survival.
When combining these variables, people with neither risk factor had significantly better survival rates than those with one or two risk factors, with 1-year survival rates of 100% versus 98% and 92%, respectively, and corresponding 5-year rates of 95% versus 82% and 42%.
“The identified multivariable risk set was not only able to predict survival, but also to identify patients at risk to develop PVD during follow-up,” write Eichstaedt and team. Specifically, in 86 patients without manifest PH at baseline who had a follow-up right heart catheterization, having at least one of the risk factors predicted the development of PVD with a sensitivity of 75% and a specificity of 69%.
Taken together, the study results show “that assessment of RV function at rest and during exercise may provide crucial information to identify SSc patients who are at a high risk of poor outcome and for the development of PH and/or PVD,” write the study authors.
They add: “Whether parameters of RV function may be positively influenced by targeted treatment still remains to be investigated.”
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