Non-invasive methods for screening pulmonary arterial hypertension in patients with systemic sclerosis
Authors:   Clinical Rehabilitation Hospital, Iasi, Romania, Dragoi Ioan-Teodor , Rezus Ciprian ,   “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania,   Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, Romania, Macovei Luana Andreea ,   Clinical Rehabilitation Hospital, Iasi, Romania,   Department of Rheumatology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania, Burlui Maria Alexandra ,   Clinical Rehabilitation Hospital, Iasi, Romania,   Department of Rheumatology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania, Mihai Ioana Ruxandra ,   Clinical Rehabilitation Hospital, Iasi, Romania,   Department of Rheumatology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania, Rezus Elena ,   Clinical Rehabilitation Hospital, Iasi, Romania,   Department of Rheumatology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
Published: December 2023

Background. Pulmonary arterial hypertension (PAH) is a very severe consequence that may arise in individuals diagnosed with Systemic Scleroderma (SSc). Transthoracic echocardiography (TTE) is an important screening method for PAH. A new useful echocardiographic marker has been noted: the ratio between the tricuspid annular plane systolic excursion and the systolic pulmonary arterial pressure (TAPSE/sPAP). This ratio correlates with invasive measurements. Objectives. In the present study, we aim to evaluate the new echocardiographic marker and correlate it with other echocardiographic markers specific to assessing PAH, with age, with form of disease, and with high risk of PAH according to the DETECT algorithm. Material and methods. An observational study that included 27 patients diagnosed with SSc according to the ACR/EULAR 2013 criteria was conducted between November 2022 and June 2023. The patients were clinically and paraclinically evaluated in the first Rheumatology Clinic, Iasi. TTE evaluation was performed in the third Internal Medicine Clinic, Iasi. The threshold value of TAPSE/CPAP was <0.6mm/mmHg. High-risk PAH was determined using the DETECT algorithm, employing the online calculator at https://www.detectionofpah.com. The statistical analysis was conducted using the PSPP 2.0.0 program. P-values of <0.05 were considered significant. Outcomes. A total of 9 patients (33.34%) presented the TAPSE/sPAP ratio value <0.6 mm/mmHg. All these patients had tricuspid regurgitation peak gradient (TRPG) >30 mmHg, and 8 of them had a value >2.8 m/s in tricuspid regurgitation velocity assessment. According to DETECT algorithm, seven patients were identified as having a high risk of PAH. They all had a TAPSE/sPAP ratio <0.6 mm/mmHg. Conclusion. The TAPSE/sPAP ratio is an effective method for assessing right ventricular coupling in patients with SSc-PAH. Given the invasive nature and difficulty associated with right heart catheterization (RHC), this echocardiographic marker can be used in screening. TTE remains an important screening tool, and a correlation between different echocardiographic variables can be an advantage in screening.