Codullo Veronica, Acquaro Mauro, Greco Alessandra, Lia Micaela, Palermo Bianca Lucia, Scelsi Laura, Schirinzi Sandra, Turco Annalisa, Zanframundo Giovanni, Montecucco Carlomaurizio, Valentini Adele, Cavagna Lorenzo, Ghio Stefano
Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
UOC Cardiologia 1, Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy.
Rheumatology (Oxford). 2025 Jul 1;64(7):4292-4298. doi: 10.1093/rheumatology/keae628.
Regular screening for pulmonary hypertension (PH) is recommended in patients with SSc for the early detection and treatment of pulmonary arterial hypertension. Whether Doppler echocardiography may predict subsequent development of PH is still unknown. In this context, there is growing awareness of the potential importance of right atrial function in reflecting an initial overload of the right heart due to the hypertensive state in the pulmonary circulation is a matter of considerable interest.
We tested the hypothesis that right atrial reservoir strain (RARs) might be a sensitive parameter to reflect an initial overload of the right heart and predict the development of PH in SSc patients.
We enrolled 113 SSc patients followed at our Scleroderma Unit from May 2010 to April 2022, who underwent a complete echocardiographic examination which included the estimate of systolic pulmonary artery systolic pressure, the measurement of tricuspid annular plane systolic excursion (TAPSE), its ratio with systolic pulmonary artery pressure (TAPSE/PAPs) and RARs.
During a subsequent median follow-up period of 43 months, 11 patients underwent right heart catheterization because of suspect PH, which was confirmed in 10 patients. At multivariable analysis, RARs was the only echocardiographic parameter with a statistically significant, independent predictive accuracy for PH (hazard ratio 0.85, 95% CI 0.75-0.96, P = 0.01). At receiver operating characteristic curves, the optimal baseline cut-off value of RARs to predict PH development was 39.6 (area under the curve 0.7, P = 0.04, sensitivity of 70% and specificity of 60%).
RARs may be a sensitive echocardiographic parameter to predict subsequent development of PH in patients with SSc.
对于系统性硬化症（SSc）患者，建议定期筛查肺动脉高压（PH），以便早期发现和治疗肺动脉高压。多普勒超声心动图是否可以预测PH的后续发展仍不清楚。在这种情况下，右心房功能在反映由于肺循环高血压状态导致的右心初始负荷过重方面的潜在重要性日益受到关注，这是一个相当有趣的问题。
我们检验了以下假设，即右心房储备应变（RARs）可能是反映右心初始负荷过重并预测SSc患者发生PH的敏感参数。
我们纳入了2010年5月至2022年4月在我们的硬皮病科随访的113例SSc患者，这些患者接受了完整的超声心动图检查，包括估计收缩期肺动脉收缩压、测量三尖瓣环平面收缩期位移（TAPSE）、其与收缩期肺动脉压的比值（TAPSE/PAPs）以及RARs。
在随后的中位随访期43个月内，11例患者因疑似PH接受了右心导管检查，其中10例得到证实。在多变量分析中，RARs是唯一对PH具有统计学显著独立预测准确性的超声心动图参数（风险比0.85，95%可信区间0.75 - 0.96，P = 0.01）。在受试者工作特征曲线分析中，预测PH发生的RARs的最佳基线截断值为39.6（曲线下面积0.7，P = 0.04，敏感性为70%，特异性为60%）。
RARs可能是预测SSc患者PH后续发展的敏感超声心动图参数。
