Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, the Netherlands.
Int J Cardiol. 2018 Dec 15;273:203-206. doi: 10.1016/j.ijcard.2018.07.122. Epub 2018 Jul 24.
Patients with systemic sclerosis (SSc) are at risk for developing pulmonary hypertension (PH) which is a major cause of death in this population. Echocardiographic (TTE) derived pulmonary arterial pressure (PAP) can be unreliable for the early detection of PH. Previous studies demonstrate that the ECG derived ventricular gradient optimized for right ventricular pressure overload (VG-RVPO) can detect PH in a heterogeneous population suspected of PH. The aim of this study is to assess the use of the VG-RVPO as a screening and monitoring instrument of early PH in SSc patients.
Serial ECGs and TTEs from twenty-seven SSc patients who underwent right heart catheterization (RHC) were retrospectively analyzed. The changes in PAP and VG-RVPO over time were studied in patients with and without diagnosed PH.
Twenty-four patients (52.5% female, mean age 58.4 years SD 14.3) were studied. In eleven patients PH was confirmed with RHC. In these patients VG-RVPO was significantly higher -8 ± 19 than in patients without PH -23 ± 10 mV·ms, (P < 0.05). In addition, in PH patients the VG-RVPO increased over time in contrast to patients without PH (P < 0.01). The VG was more sensitive to detect disease progression in earlier stages of disease as compared to echocardiographic derived PAP.
The VG-RVPO is a sensitive, non-invasive and cost effective tool for early detection of PH in SSc patients. Serial measurements indicate that the VG-RVPO can be used as a follow-up instrument and outperforms TTE to detect early changes in right ventricular pressure over time.
系统性硬化症（SSc）患者存在发生肺动脉高压（PH）的风险，而 PH 是该人群死亡的主要原因。超声心动图（TTE）衍生的肺动脉压力（PAP）可能无法可靠地早期检测 PH。先前的研究表明，针对右心室压力超负荷进行优化的心电图衍生右心室压力梯度（VG-RVPO）可在疑似 PH 的异质人群中检测到 PH。本研究旨在评估 VG-RVPO 作为 SSc 患者早期 PH 的筛查和监测工具的应用。
回顾性分析了 27 例接受右心导管检查（RHC）的 SSc 患者的系列心电图和 TTE。研究了有和无诊断 PH 的患者中 PAP 和 VG-RVPO 随时间的变化。
共纳入 24 例患者（52.5%女性，平均年龄 58.4±14.3 岁）。11 例患者通过 RHC 确诊 PH。在这些患者中，VG-RVPO 明显高于无 PH 的患者（-8±19 比-23±10 mV·ms，P<0.05）。此外，与无 PH 的患者相比，PH 患者的 VG-RVPO 随时间增加（P<0.01）。与超声心动图衍生的 PAP 相比，VG 更能敏感地检测疾病早期阶段的进展。
VG-RVPO 是一种敏感、无创且具有成本效益的工具，可用于早期检测 SSc 患者的 PH。连续测量表明，VG-RVPO 可作为随访工具，并且比 TTE 更能检测到右心室压力随时间的早期变化。
