Department of Rheumatology, Oslo University Hospital-Rikshospitalet, Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Rheumatology (Oxford). 2018 Mar 1;57(3):480-487. doi: 10.1093/rheumatology/kex435.
The DETECT algorithm was developed for screening patients with SSc at high risk of pulmonary arterial hypertension (PAH). We evaluated the impact of this algorithm in a SSc population.
Patients from the unselected, prospective Oslo University Hospital SSc study were divided into the Early and DETECT cohorts, respectively, depending on whether an incident right heart catheterization (RHC) was performed before (2009-13) or after (2014-17) the DETECT algorithm was instituted. A PAH diagnosis and patient risk stratification (low, intermediate and high risk) were performed according to 2015 European Society of Cardiology guidelines.
At the time of the incident RHC, PAH frequency was similar between the DETECT (15/84 with PAH; 18%) and Early (16/77; 21%) cohorts, but more patients had borderline pulmonary hypertension (PH) in the DETECT (31%) than in the Early (17%) cohort. PAH risk levels were distributed differently. In the DETECT cohort, 27% and 27% were at low and high risk, respectively, at the time of PAH diagnosis. In the Early cohort, 19 and 44% were at low and high risk, respectively. A follow-up RHC, performed after [mean (SD)] 2.4 (1.8) years, showed that 39% of patients with borderline PH in the Early cohort had developed PAH.
The DETECT algorithm did not alter PAH incidence in this unselected SSc population. However, it appeared to affect the risk distribution at the time of PAH diagnosis and increased the frequency of borderline PH cases. These findings may translate into novel opportunities for earlier PAH treatment and, possibly, prevention.
DETECT 算法是为筛查有发生肺动脉高压（PAH）风险的系统性硬化症（SSc）患者而开发的。我们评估了该算法在 SSc 人群中的影响。
根据是否在实施 DETECT 算法之前（2009-13 年）或之后（2014-17 年）进行偶然的右心导管检查（RHC），将来自未选择的前瞻性奥斯陆大学医院 SSc 研究的患者分别分为早期和 DETECT 队列。根据 2015 年欧洲心脏病学会指南进行 PAH 诊断和患者风险分层（低、中、高风险）。
在偶然的 RHC 时，DETECT 组（PAH 患者 15/84，18%）和早期组（PAH 患者 16/77，21%）的 PAH 发生率相似，但 DETECT 组（31%）比早期组（17%）有更多的患者有边界性肺动脉高压（PH）。PAH 风险水平分布不同。在 DETECT 队列中，27%和 27%的患者在 PAH 诊断时分别处于低危和高危状态。在早期队列中，19%和 44%的患者分别处于低危和高危状态。随后进行的 RHC 随访[平均（SD）]2.4（1.8）年后显示，早期队列中边界性 PH 的 39%患者已发展为 PAH。
DETECT 算法在这个未选择的 SSc 人群中并未改变 PAH 的发生率。然而，它似乎影响了 PAH 诊断时的风险分布，并增加了边界性 PH 病例的频率。这些发现可能为早期 PAH 治疗提供新的机会，可能还有预防机会。
