Hospital for Special Surgery, New York, New York.
Arthritis Care Res (Hoboken). 2013 Oct;65(10):1713-8. doi: 10.1002/acr.22051.
Pulmonary hypertension (PH) is a leading cause of death in patients with systemic sclerosis (SSc; scleroderma). Although right-sided heart catheterization (RHC) is the gold standard for diagnosing PH, it is an invasive test with associated risks. The submaximal heart and pulmonary evaluation (step test) is a noninvasive, submaximal stress test that could be used to identify patients with PH. The purpose of this study is to assess the correlation between change in end tidal carbon dioxide (ΔPETCO2 ) from rest to end-exercise on the step test and mean pulmonary artery pressure (mPAP) on RHC in SSc patients.
This is a retrospective cohort study of patients with limited or diffuse cutaneous SSc who were evaluated in an academic cardiology practice between November 2007 and November 2011 and underwent a step test and RHC. Statistical analysis was performed using Spearman's correlation test and multivariable linear regression.
A total of 679 charts were reviewed. Nineteen SSc patients who underwent a step test and RHC were included. ΔPETCO2 was negatively correlated with mPAP (r = -0.82, P < 0.0001). In a multivariable linear regression model evaluating the relationship between ΔPETCO2 and mPAP, controlling for age, sex, and time between and order of step test and RHC, ΔPETCO2 remained the only variable statistically significantly associated with mPAP (P < 0.001). The step test had a sensitivity of 100%, specificity of 75%, positive predictive value of 93.8%, and negative predictive value of 100% for the diagnosis of PH.
ΔPETCO2 on the step test has a strong, statistically significant negative correlation with mPAP on RHC.
肺动脉高压（PH）是系统性硬皮病（SSc；硬皮症）患者死亡的主要原因。尽管右心导管检查（RHC）是诊断 PH 的金标准，但它是一种具有相关风险的侵入性检查。次最大心脏和肺评估（台阶试验）是一种非侵入性的次最大应激试验，可用于识别 PH 患者。本研究的目的是评估台阶试验中休息至运动结束时呼气末二氧化碳（ΔPETCO2）的变化与 RHC 中平均肺动脉压（mPAP）之间的相关性在 SSc 患者中。
这是一项回顾性队列研究，纳入了 2007 年 11 月至 2011 年 11 月在学术心脏病学实践中接受评估的局限性或弥漫性皮肤 SSc 患者，并进行了台阶试验和 RHC。使用 Spearman 相关检验和多变量线性回归进行统计分析。
共回顾了 679 份图表。纳入了 19 名接受台阶试验和 RHC 的 SSc 患者。ΔPETCO2 与 mPAP 呈负相关（r=-0.82，P<0.0001）。在评估 ΔPETCO2 与 mPAP 之间关系的多变量线性回归模型中，控制年龄、性别以及台阶试验和 RHC 之间的时间和顺序，ΔPETCO2 仍然是唯一与 mPAP 统计学显著相关的变量（P<0.001）。台阶试验对 PH 的诊断具有 100%的敏感性、75%的特异性、93.8%的阳性预测值和 100%的阴性预测值。
台阶试验中 ΔPETCO2 与 RHC 中 mPAP 呈强烈的、统计学显著的负相关。
