Universität zu Köln

Dumitrescu, Daniel, Nagel, Christian, Kovacs, Gabor, Bollmann, Tom, Halank, Michael, Winkler, Joerg, Hellmich, Martin, Gruenig, Ekkehard, Olschewski, Horst ORCID: 0000-0002-2834-7466, Ewert, Ralf and Rosenkranz, Stephan (2017). Cardiopulmonary exercise testing for detecting pulmonary arterial hypertension in systemic sclerosis. Heart, 103 (10). S. 774 - 783. LONDON: BMJ PUBLISHING GROUP. ISSN 1468-201X

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Abstract

Objectives Pulmonary arterial hypertension (PAH) is a devastating disease with limited survival and occurs as a frequent complication in patients with systemic sclerosis (SSc). A definite diagnosis of PAH is obtained by right heart catheterisation (RHC); however, the initial suspicion is raised by non-invasive methods. We assessed the diagnostic accuracy of key parameters derived from cardiopulmonary exercise testing (CPET) for detecting and ruling out SSc-associated PAH. Methods In a multicentre setting, we prospectively evaluated 173 consecutive patients with SSc without known PAH, but with clinical suspicion of PAH. Each patient underwent CPET and RHC. Results RHC identified PAH in 48 patients (27.8%), postcapillary pulmonary hypertension (PH) in 10 patients (5.8%) and ruled out PH in 115 patients (66.5%). CPET parameters correlated significantly with pulmonary haemodynamics. PeakVO(2) and VE/VCO2 showed highest correlations with pulmonary arterial pressure, transpulmonary pressure gradient and pulmonary vascular resistance. Several parameters showed high sensitivity and specificity for PAH detection by receiver operating characteristic analysis. However, peakVO(2) showed highest diagnostic accuracy (sensitivity 87.5%, specificity 74.8% at a threshold level of 13.8 mL/min/ kg). A peakVO2 of >18.7 mL/kg/min was reached by 38/173 patients (22%) and excluded PAH in our cohort (negative predictive value 1.0). A nadir VE/VCO2 ratio of >45.5 showed a positive predictive value of 1.0. Diagnostic accuracy was highest in patients with low pulmonary arterial wedge pressure (<12 mm Hg). There were no study-related serious adverse events. Conclusions CPET is a safe and valuable method in the non-invasive detection of SSc-associated PAH. It may be particularly beneficial for reducing unnecessary RHC procedures.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Dumitrescu, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED Nagel, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Kovacs, Gabor UNSPECIFIED UNSPECIFIED UNSPECIFIED Bollmann, Tom UNSPECIFIED UNSPECIFIED UNSPECIFIED Halank, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Winkler, Joerg UNSPECIFIED UNSPECIFIED UNSPECIFIED Hellmich, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Gruenig, Ekkehard UNSPECIFIED UNSPECIFIED UNSPECIFIED Olschewski, Horst UNSPECIFIED orcid.org/0000-0002-2834-7466 UNSPECIFIED Ewert, Ralf UNSPECIFIED UNSPECIFIED UNSPECIFIED Rosenkranz, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-232408
DOI:	10.1136/heartjnl-2016-309981
Journal or Publication Title:	Heart
Volume:	103
Number:	10
Page Range:	S. 774 - 783
Date:	2017
Publisher:	BMJ PUBLISHING GROUP
Place of Publication:	LONDON
ISSN:	1468-201X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PREVALENCE; DIAGNOSIS Multiple languages Cardiac & Cardiovascular Systems Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/23240