Algorithm aids in screening for pulmonary hypertension in patients with systemic sclerosis
Use of the DETECT algorithm was a better screening tool for systemic sclerosis-associated peripheral arterial hypertension than transthoracic echocardiogram, according to results of a new study.
“We’ve been advocating for a long time that every scleroderma patient should be screened on an annual basis using DETECT, and this data supports that,” Dinesh Khanna, MBBS, MSc, director of Michigan Medicine’s Scleroderma Program, said in a press release. “Pulmonary arterial hypertension is a leading cause of death for these patients, and we want to diagnose them early.”
The cross-sectional study included 68 adults (mean age, 60 years; 85.3% women) with systemic sclerosis who underwent diagnostic right heart catheterization for evaluation of pulmonary hypertension. Fifty-eight patients did not have pulmonary hypertension and 10 had PAH. Fifty-eight percent of patients had limited cutaneous systemic sclerosis. All had variables for application of the DETECT algorithm and the 2015 European Society of Cardiology/European Respiratory Society guidelines. The guidelines used the 2018 revised hemodynamic definition of PAH.
The DETECT algorithm is a two-step algorithm that uses six different clinical variables to determine whether a patient requires an echocardiogram of the heart. The second step then informs whether the patient should be referred for a right heart catheterization.
Researchers performed sensitivity analyses and analyzed the predictive accuracy of the DETECT algorithm and the ESC/ERS guidelines, including individuals with diffusion capacity for carbon monoxide (DLCO) of at least 60% predicted.
The DETECT algorithm had a sensitivity of 1.0 (95% CI, 0.69-1) and a negative predictive value of 1.0 (95% CI, 0.8-1) compared with a sensitivity of 0.8 (95% CI, 0.44-0.97) and a negative predictive value of 0.94 (95% CI, 0.81-0.99) for the ESC/ERS guidelines.
Among the 27 individuals with DLCO of at least 60% predicted, the DETECT algorithm had a sensitivity of 1.0 (95% CI, 0.29-1) and a negative predictive value of 1.0 (95% CI, 0.59-1) compared with a sensitivity of 0.67 (95% CI, 0.09-0.99) and a negative predictive value of 0.94 (95% CI, 0.71-1) for the ESC/ERS guidelines.
The DETECT algorithm “didn’t miss a single patient; it can’t get better than that,” Khanna said in the release. “This is a highly sensitive screening tool and can be very useful.”
This study was the first to compare the DETECT algorithm with the echocardiogram guidelines published in 2015, according to the researchers.