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Evidence-based detection of pulmonary arterial hypertens...

14/06/2013 - by maria michailidou
Evidence-based detection of pulmonary arterial hypertension in systemic sclerosis: the DETECT studyAbstract




Objective
Earlier detection of pulmonary arterial hypertension (PAH), a leading
cause of death in systemic sclerosis (SSc), facilitates
earlier treatment. The objective of
this study was to develop the first evidence-based detection algorithm
for PAH in SSc.






Methods In
this cross-sectional, international study conducted in 62 experienced
centres from North America, Europe and Asia, adults
with SSc at increased risk of PAH
(SSc for >3 years and predicted pulmonary diffusing capacity for
carbon monoxide <60%) underwent
a broad panel of non-invasive
assessments followed by diagnostic right heart catheterisation (RHC).
Univariable and multivariable
analyses selected the best
discriminatory variables for identifying PAH. After assessment for
clinical plausibility and feasibility,
these were incorporated into a
two-step, internally validated detection algorithm. Nomograms for
clinical practice use were
developed.






Results Of
466 SSc patients at increased risk of PAH, 87 (19%) had RHC-confirmed
PAH. PAH was mild (64% in WHO functional class I/II).
Six simple assessments in Step 1 of
the algorithm determined referral to echocardiography. In Step 2, the
Step 1 prediction
score and two echocardiographic
variables determined referral to RHC. The DETECT algorithm recommended
RHC in 62% of patients
(referral rate) and missed 4% of PAH
patients (false negatives). By comparison, applying European Society of
Cardiology/European
Respiratory Society guidelines to
these patients, 29% of diagnoses were missed while requiring an RHC
referral rate of 40%.






Conclusions The novel, evidence-based DETECT algorithm for PAH detection in SSc is a sensitive, non-invasive tool which minimises missed
diagnoses, identifies milder disease and addresses resource usage.


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