Screening for pulmonary hypertension in systemic sclerosis:: the longitudinal development of tricuspid gradient in 227 consecutive patients, 1992-2001
Screening for pulmonary hypertension in systemic sclerosis:: the longitudinal development of tricuspid gradient in 227 consecutive patients, 1992-2001
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DOI：
10.1093/rheumatology/keh486
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发表时间：
2005-03-01
期刊：
影响因子：
5.5
通讯作者：
Åkesson, A
中科院分区：
文献类型：
--
作者：
Hesselstrand, R;Ekman, R;Åkesson, A
目标。探讨三尖瓣梯度（TG）的纵向发展对系统性硬化症（SSc）肺动脉高压（PAH）筛查的价值。对227例SSc患者进行了506次多普勒超声心动图评估TG。通过分析76例TG临界升高（TG 24- 38mmhg）患者的前脑利钠肽（proBNP）、降钙素基因相关肽、血栓调节蛋白和血管性血友病因子，并与10例TG正常（38mmhg）患者进行比较，评估生化标志物对TG水平和发展的预测价值。在第一个评估点，102例患者（44.9%）和139例患者（61.2%）分别发现TG bbb23 mmHg，累积随访。最初测量了24例患者（10.6%）的TG值>33 mmHg，随后评估了38例患者（16.7%）的TG值。年龄和间质性肺疾病（ILD）的存在与初始和随访时更频繁地发生TG bbb23和bbb330mmhg相关，但与进展率无关。TG（平均+/- s.d）的变化为1.34 +/- 4.55 mmHg/yr。ProBNP与tg相关。TG升高，提示可能存在多环芳烃，在SSc中是常见且进行性的。年龄和ILD增加TG升高的风险。有或没有ILD的患者有相似的TG进展。ProBNP有可能作为TG的辅助手段来选择有创治疗的患者。
Objective. To evaluate the longitudinal development of the tricuspid gradient (TG) for screening for pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc).Methods. Doppler echocardiography was performed 506 times in order to estimate TG in 227 consecutive patients with SSc. The value of biochemical markers for predicting TG levels and development was assessed through analyses of pro-brain natriuretic peptide (proBNP), calcitonin-gene related peptide, thrombomodulin and von Willebrand factor in 76 patients with a borderline increase in TG, defined as TG 24-38 mmHg, and for the purpose of comparison also in 10 patients with a normal TG ( 38 mmHg).Results. TG >23 mmHg was found in 102 patients (44.9%) at the first assessment point and in 139 patients (61.2%) respectively, cumulatively at follow-up. TG values >33 mmHg were measured in 24 patients (10.6%) initially and in 38 patients (16.7%) cumulatively in a subsequent assessment. Age and the presence of interstitial lung disease (ILD) were associated with more frequent occurrence of TG >23 and >33 mmHg initially and at follow-up, but were not associated with progression rate. The change in TG (mean +/- s.d.) was 1.34 +/- 4.55 mmHg/yr. ProBNP correlated to TG.Conclusion. An increased TG, indicating possible PAH, is common and progressive in SSc. Age and ILD increase the risk of increased TG. Patients with or without ILD have similar progression of TG. ProBNP has potential as an adjunct to TG in selecting patients eligible for invasive treatment.