Stress Echocardiographic Prediction of Emerging Pulmonary Vascular Disease in Systemic Sclerosis.
Stress Echocardiographic Prediction of Emerging Pulmonary Vascular Disease in Systemic Sclerosis.
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系统性硬化症中新发肺血管疾病的负荷超声心动图预测。
DOI：
10.1016/j.echo.2022.10.006
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Mukherjee,Monica
中科院分区：
文献类型：
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作者：
Lu,Jim;Jani,Vivek;Mercurio,Valentina;Hsu,Steven;Hummers,LauraK;Wigley,Fredrick;Hassoun,PaulM;Mathai,StephenC;Shah,AmiA;Mukherjee,Monica
系统性硬化症（SSc）患者的肺动脉高压（PAH）和右心室（RV）功能障碍的发病率和死亡率不成比例[1]。二维斑点追踪超声心动图（2D-STE）可用于无创评估有PAH风险的SSc患者的RV收缩储备受损[2，3]。然而，目前还没有建立统计学模型来预测系统性硬化症中新出现的肺血管疾病（PVD）。在本研究中，我们首先试图确定RV收缩储备异常是否与未来肺动脉压升高有关。然后，我们试图确定是否在2D-STE衍生应变与运动的变化，提高预测PAH的SSc.We研究了流行SSc患者没有已知的PVD进行仰卧位自行车超声心动图（SBE）和随后的RHC。入选标准包括：常规筛选超声心动图显示静息RVSP≥ 40 mmHg，伴有呼吸困难，常规筛选超声心动图显示RVSP≥ 45 mmHg，无症状，或在无症状性间质性肺病、严重慢性阻塞性肺病（FEV 1/FVC比值< 0.7，有吸烟史）或左心室（LV）射血分数<50%的情况下不明原因的呼吸困难。该研究方案由约翰霍普金斯医学机构审查委员会批准。所有参与者均符合美国流变学学会SSc分类标准[4，5]。患者在连续超声心动图监测下运动至疲劳。RV收缩压（RVSP），三尖瓣
Systemic sclerosis (SSc) patients experience disproportionate morbidity and mortality from pulmonary arterial hypertension (PAH) and right ventricular (RV) dysfunction [1]. Twodimensional speckle tracking echocardiography (2D-STE) can be used for noninvasive assessment of impaired RV contractile reserve in SSc patients at risk for PAH [2, 3]. However, there are no established statistical models that are predictive of emerging pulmonary vascular disease (PVD) in systemic sclerosis. In the present study, we first sought to establish whether abnormal RV contractile reserve associates with future elevation in pulmonary arterial pressures. We then sought to identify whether changes in 2D-STE derived strain with exercise improve prediction of PAH in SSc.We studied prevalent SSc patients without known PVD who underwent supine bicycle echocardiography (SBE) and subsequent RHC. Inclusion criteria included: resting RVSP≥ 40 mmHg on a routine screening echocardiogram with associated dyspnea, an RVSP≥ 45 mmHg on routine screening echocardiogram without symptoms, or unexplained dyspnea in the absence of symptomatic interstitial lung disease, significant chronic obstructive pulmonary disease (FEV1/FVC ratio< 0.7 with history of smoking), or a left ventricular (LV) ejection fraction< 50%. The study protocol was approved by the Johns Hopkins Medicine Institutional Review Board. All participants met the American College of Rheumatology classification criteria for SSc [4, 5]. Patients were exercised to fatigue with continuous echocardiographic monitoring. RV systolic pressure (RVSP), tricuspid