Reduced diffusing capacity for carbon monoxide predicts borderline pulmonary arterial pressure in patients with systemic
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Rheumatology International https://doi.org/10.1007/s00296-019-04370-0
INTERNATIONAL
OBSERVATIONAL RESEARCH
Reduced diffusing capacity for carbon monoxide predicts borderline pulmonary arterial pressure in patients with systemic sclerosis Keita Ninagawa1 · Masaru Kato1 · Hiroyuki Nakamura1 · Nobuya Abe1 · Michihito Kono1 · Yuichiro Fujieda1 · Kenji Oku1 · Shinsuke Yasuda1 · Hiroshi Ohira2 · Ichizo Tsujino2 · Tatsuya Atsumi1 Received: 9 June 2019 / Accepted: 3 July 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Early intervention in pulmonary arterial hypertension associated with systemic sclerosis (SSc) may improve its prognosis. We aimed to establish an algorithm to detect mean pulmonary artery pressure (mPAP) > 20 mmHg using non-invasive examinations in SSc patients by modifying the DETECT algorithm. This study included SSc patients who underwent right heart catheterization (RHC) in our hospital during 2010–2018. Following variables were assessed for performance to predict mPAP ≥ 25 mmHg or > 20 mmHg; anti-centromere or U1-RNP antibody, plasma BNP level, serum urate level, right axis deviation, forced vital capacity (FVC)/diffusing capacity for carbon monoxide (DLCO) ratio, and tricuspid regurgitation velocity. Of 58 patients enrolled in this study, 24 had mPAP of ≥ 25 mmHg and 9 had mPAP of 21–24 mmHg. Among variables tested, only FVC/DLCO elevated similarly in patients with mPAP of ≥ 25 mmHg (median 2.5) and those with mPAP of 21–24 mmHg (median 2.5) compared to those with mPAP of ≤ 20 mmHg (median 1.5). Given the particularly good correlation between DLCO and mPAP of > 20 mmHg, each variable was weighted according to its odds ratio and the total weighted score was calculated. The total weighted score exhibited a good predictive performance for mPAP of > 20 mmHg with its sensitivity of 87.5% and specificity of 92%. Among conventional risk factors for PAH, decreased DLCO may predict mPAP > 20 mmHg with priority in SSc patients. Weighting DLCO may improve the performance of screening algorithm for early SSc-PAH. Keywords Pulmonary arterial hypertension · Systemic sclerosis · Screening · FVC/DLCO
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00296-019-04370-0) contains supplementary material, which is available to authorized users. * Masaru Kato [email protected]
Shinsuke Yasuda [email protected]
Keita Ninagawa [email protected]
Hiroshi Ohira [email protected]
Hiroyuki Nakamura [email protected]
Ichizo Tsujino [email protected]
Nobuya Abe [email protected]
Tatsuya Atsumi [email protected]
Michihito Kono m‑[email protected]
1
Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15W7, Kita‑ku, Sapporo, Japan
2
First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan
Yuichiro Fujieda [email protected] Kenji Oku kenoku@me
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