The Use of Transthoracic Echocardiogram to Quantify Pulmonary Vascular Resistance in Patients with Systemic Sclerosis

Sophie Billet; Grégory Pugnet; Thomas Chollet; Gaétan Charbonnier; Pauline Fournier; Grégoire Prévot; Laurent Tetu; Maxime Cournot; Hélène Derumeaux; Didier Carrié; Michel Galinier; Olivier Lairez

doi:10.3899/jrheum.180571

The Use of Transthoracic Echocardiogram to Quantify Pulmonary Vascular Resistance in Patients with Systemic Sclerosis

J Rheumatol. 2019 Nov;46(11):1495-1501. doi: 10.3899/jrheum.180571. Epub 2019 Mar 1.

Authors

Sophie Billet^{1

2}, Grégory Pugnet^{3

4}, Thomas Chollet^{1

2}, Gaétan Charbonnier^{1

2}, Pauline Fournier^{1

2}, Grégoire Prévot^{1

2}, Laurent Tetu^{1

2}, Maxime Cournot^{1

2}, Hélène Derumeaux^{1

2}, Didier Carrié^{1

2}, Michel Galinier^{1

2}, Olivier Lairez^{1

2}

Affiliations

¹ From the Department of Cardiology, Rangueil University Hospital; Cardiac Imaging Centre, Toulouse University Hospital; UMR 1027, INSERM, Faculté de Médecine, Université de Toulouse III; Medical School of Rangueil, University Paul Sabatier; Department of Internal Medicine, University Hospital of Purpan; Department of Pneumology, Larrey University Hospital, Toulouse; Department of Cardiology, La Réunion University Hospital, Saint-Pierre; INSERM, UMR 1188, Sainte-Clothilde; Département d'Information Médicale, Centre Hospitalier Universitaire de Toulouse; Medical School of Purpan, University Paul Sabatier; Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France.
² S. Billet, MD, Department of Cardiology, Rangueil University Hospital, and Cardiac Imaging Centre, Toulouse University Hospital; G. Pugnet, MD, PhD, UMR 1027, INSERM, Faculté de Médecine, Université de Toulouse III, and Medical School of Rangueil, University Paul Sabatier, and Department of Internal Medicine, University Hospital of Purpan; T. Chollet, MD, Department of Cardiology, Rangueil University Hospital, and Cardiac Imaging Centre, Toulouse University Hospital; G. Charbonnier, MD, Department of Cardiology, Rangueil University Hospital, and Cardiac Imaging Centre, Toulouse University Hospital; P. Fournier, MD, Department of Cardiology, Rangueil University Hospital, and Cardiac Imaging Centre, Toulouse University Hospital; G. Prévot, MD, Department of Pneumology, Larrey University Hospital; L. Tetu, MD, Department of Pneumology, Larrey University Hospital; M. Cournot, MD, PhD, Department of Cardiology, La Réunion University Hospital, and INSERM, UMR 1188, Sainte-Clothilde; H. Derumeaux, MD, PhD, Département d'Information Médicale, Centre Hospitalier Universitaire de Toulouse; D. Carrié, MD, PhD, Department of Cardiology, Rangueil University Hospital, and Cardiac Imaging Centre, Toulouse University Hospital, and Medical School of Purpan, University Paul Sabatier; M. Galinier, MD, PhD, Department of Cardiology, Rangueil University Hospital, and Cardiac Imaging Centre, Toulouse University Hospital, and Medical School of Rangueil, University Paul Sabatier; O. Lairez, MD, PhD, Department of Cardiology, Rangueil University Hospital, and Cardiac Imaging Centre, Toulouse University Hospital, and Medical School of Rangueil, University Paul Sabatier, and Department of Nuclear Medicine, Toulouse University Hospital.
³ From the Department of Cardiology, Rangueil University Hospital; Cardiac Imaging Centre, Toulouse University Hospital; UMR 1027, INSERM, Faculté de Médecine, Université de Toulouse III; Medical School of Rangueil, University Paul Sabatier; Department of Internal Medicine, University Hospital of Purpan; Department of Pneumology, Larrey University Hospital, Toulouse; Department of Cardiology, La Réunion University Hospital, Saint-Pierre; INSERM, UMR 1188, Sainte-Clothilde; Département d'Information Médicale, Centre Hospitalier Universitaire de Toulouse; Medical School of Purpan, University Paul Sabatier; Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France. [email protected].
⁴ S. Billet, MD, Department of Cardiology, Rangueil University Hospital, and Cardiac Imaging Centre, Toulouse University Hospital; G. Pugnet, MD, PhD, UMR 1027, INSERM, Faculté de Médecine, Université de Toulouse III, and Medical School of Rangueil, University Paul Sabatier, and Department of Internal Medicine, University Hospital of Purpan; T. Chollet, MD, Department of Cardiology, Rangueil University Hospital, and Cardiac Imaging Centre, Toulouse University Hospital; G. Charbonnier, MD, Department of Cardiology, Rangueil University Hospital, and Cardiac Imaging Centre, Toulouse University Hospital; P. Fournier, MD, Department of Cardiology, Rangueil University Hospital, and Cardiac Imaging Centre, Toulouse University Hospital; G. Prévot, MD, Department of Pneumology, Larrey University Hospital; L. Tetu, MD, Department of Pneumology, Larrey University Hospital; M. Cournot, MD, PhD, Department of Cardiology, La Réunion University Hospital, and INSERM, UMR 1188, Sainte-Clothilde; H. Derumeaux, MD, PhD, Département d'Information Médicale, Centre Hospitalier Universitaire de Toulouse; D. Carrié, MD, PhD, Department of Cardiology, Rangueil University Hospital, and Cardiac Imaging Centre, Toulouse University Hospital, and Medical School of Purpan, University Paul Sabatier; M. Galinier, MD, PhD, Department of Cardiology, Rangueil University Hospital, and Cardiac Imaging Centre, Toulouse University Hospital, and Medical School of Rangueil, University Paul Sabatier; O. Lairez, MD, PhD, Department of Cardiology, Rangueil University Hospital, and Cardiac Imaging Centre, Toulouse University Hospital, and Medical School of Rangueil, University Paul Sabatier, and Department of Nuclear Medicine, Toulouse University Hospital. [email protected].

PMID: 30824639
DOI: 10.3899/jrheum.180571

Abstract

Objective: To explore the accuracy of tricuspid regurgitation velocity (TRV) to right ventricular outflow tract time-velocity integral (TVI_RVOT) ratio by Doppler to determine pulmonary vascular resistance (PVR) in patients with systemic sclerosis (SSc).

Methods: Thirty-five consecutive adult patients with SSc, fulfilling the 2013 European League Against Rheumatism/American College of Rheumatology classification criteria, with sinus rhythm referred for right heart catheterization (RHC), were retrospectively included. All patients underwent a transthoracic echocardiogram (TTE) performed within 24 h of RHC. Patients with SSc were recruited regardless of disease activity, cardiac symptoms, and treatment regimen. Doppler measurements were compared to RHC measurements. A linear regression equation was generated to predict PVR by echocardiogram based on the TRV/TVI_RVOT ratio. The accuracy of Doppler measurements for predicting PVR > 3 Wood units was assessed by computing the areas under the receiver-operating characteristic curves.

Results: There were 20 (57%) females in the study. The mean age was 65 ± 12 years. Mean and systolic pulmonary arterial pressures were 31 ± 8 and 53 ± 15 mmHg, respectively. There was a good correlation between TRV/TVI_RVOT ratio assessed by Doppler and PVR measured by RHC (R = 0.743, p < 0.001). The equation generated by this analysis was the following: PVR by Doppler = 11.3 × (TRV/TVI_RVOT) + 1.7. A cutoff value of 0.21 for TRV/TVI_RVOT ratio provided the best sensitivity (86%) and specificity (86%) to determine PVR > 3 Wood units.

Conclusion: Our study suggests that TTE using Doppler could be a useful and noninvasive tool for estimating PVR in patients with SSc.

Keywords: PULMONARY HYPERTENSION; SYSTEMIC SCLEROSIS; TRANSTHORACIC ECHOCARDIOGRAM.

MeSH terms

Aged
Blood Flow Velocity
Blood Pressure
Cardiac Catheterization / methods
Cross-Sectional Studies
Data Accuracy
Echocardiography, Doppler / methods*
Female
Heart Rate
Humans
Hypertension, Pulmonary / diagnostic imaging*
Hypertension, Pulmonary / epidemiology
Male
Middle Aged
Prevalence
Pulmonary Artery / physiology
Retrospective Studies
Scleroderma, Systemic / diagnostic imaging*
Sensitivity and Specificity
Stroke Volume
Vascular Resistance*