Right Ventricular Systolic Pressure Assessed by Echocardiography: A Predictive Factor of Mortality in Patients With Scleroderma

作者：Kiatchoosakun Songsak^*; Wongvipa**** Chaiyasith; Nanagara Ratanavadee; Hoit Brian D

来源：Clinical Cardiology, 2011, 34(8): 488-493.

DOI：10.1002/clc.20920

Background: Pulmonary arterial hypertension (PAH) is a well-known complication of systemic sclerosis (SSc). Doppler echocardiographic screening for the detection of PAH (by measuring right ventricular systolic pressure [RVSP]) is therefore recommended for all patients with SSc. However, the validity of RVSP as a predictor of mortality in patients with SSc is not well established.
Hypothesis: Doppler-determined PAH identifies a high-risk subset of patients with SSc with decreased survival.
Methods: We performed echocardiography in 155 consecutive patients with SSc between May 2005 and July 2006 and tested the value of an RVSP level of >= 36 mm Hg to predict mortality. Cox proportional hazards model was used to examine the individual relationship between each variable and the mortality rate.
Results: Tricuspid regurgitant jets for RVSP determination were quantified in 129 patients (82.6%), of which 47 (36.4%) had RVSP >= 36 mm Hg. The median follow-up time was 34 months. The 1-, 2-, and 3-year survival rates were significantly lower among SSc patients with RVSP >= 36 vs <= 36 mm Hg (82%, 78%, and 67% vs 98%, 90%, and 86%, respectively, P < 0.01 by Wilcoxon test). In a multivariate analysis including echocardiographic and clinical variables, only an RVSP 236 mm Hg and a New York Heart Association III/IV class were associated with increased mortality; the respective Cox hazard ratios were 2.22 (95% confidence interval [CI]: 1.01-4.89, P = 0.048) and 4.77 (95% Cl: 2.09-10.90, P = 0.000).
Conclusions: Our results indicate that Doppler RVSP identifies a high-risk subset and supports the use of Doppler RVSP as a screening test in patients with SSc who may warrant early treatment of their PAH.

• 出版日期2011-8