P709How frequently should echocardiographic screening for pulmonary hypertension be performed in scleroderma?


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Abstract

Background: Current guidelines endorse echocardiographic screening of even asymptomatic patients with the scleroderma (Scl) spectrum of diseases for pulmonary hypertension (PHT). The evidence for this approach is limited. We examined serial echocardiographic data on our cohort of Scl patients to further inform about the appropriate interval for serial studies.Methods: Clinical and echocardiographic data was collected on all patients referred to our tertiary Scl clinic between April 2007 and January 2011. Echocardiographic data included tricuspid regurgitant velocity (TR Vel), pulmonary vascular resistance estimated non-invasively according to the method validated by Abbas (PVR) and right ventricular longitudinal systolic tissue velocity (RVS'). Changes in TR Vel over time were compared in those patients with serial testing.Results: 170 studies were performed in 107 patients (age 55±15 years, 93% female, median duration of disease 4.7 years and modified Rodnan skin score 6.1±6.7). Feasibility for assessment of TR Vel, PVR and RVS' was 66%, 60% and 91% respectively. Across the population TR Vel was 2.3±0.4m/sec, PVR was 1.88±0.47 Wood units and RVS' was 12.5±2.6cm/sec. The prevalence of possible/likely PHT based on the ESC definition of TR Vel >2.8m/sec was 7%. Of 47 patients with at least two echocardiograms there were 32 patients with adequate Doppler for assessment of TR Vel in both studies. The median interval between studies was 14 months. There was no significant change seen in TR Vel between the two studies (Figure 1). No patients who did not fulfil the criterion for PHT on their first study moved into that category on the follow-up study.Conclusion: Parameters of PHT change slowly in patients with Scl. Echocardiographic screening in Scl may not need to be performed annually.

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