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


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]


OBJECTIVE : To explore the accuracy of tricuspid regurgitation velocity (TRV) to right ventricular outflow tract time-velocity integral (TVIRVOT) 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/TVIRVOT 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/TVIRVOT 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/TVIRVOT) + 1.7. A cutoff value of 0.21 for TRV/TVIRVOT ratio provided the best sensitivity (86%) and specificity (86%) to determine PVR > 3 Wood units.
CONCLUSIONS : Our study suggests that TTE using Doppler could be a useful and noninvasive tool for estimating PVR in patients with SSc.