Right atrial reservoir strain as an early predictor of pulmonary hypertension development in systemic sclerosis: a single-centre pilot study

Abstract

Introduction: 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.

Aim: 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.

Methods: 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.

Results: 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%).

Conclusion: RARs may be a sensitive echocardiographic parameter to predict subsequent development of PH in patients with SSc.

Keywords: echocardiography; prediction; screening; strain; systemic sclerosis.