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Screening for pulmonary arterial hypertension in systemic sclerosis

^* Pulmonary Hypertension and Heart Failure Clinic, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium. ^# Royal Free and University College Medical School, London, UK.

CORRESPONDENCE: J-L Vachiéry, Pulmonary Hypertension and Heart Failure Clinic, Hôpital Erasme, Université Libre de Bruxelles, 808 Route de Lennik, 1070 Brussels, Belgium. E-mail: jvachier{at}ulb.ac.be

Received: June 1, 2009
Accepted June 24, 2009

ABSTRACT

The onset and progression of pulmonary arterial hypertension (PAH) in patients with systemic sclerosis (SSc) can be particularly aggressive; however, effective treatments are available. Therefore, early identification of patients with suspected PAH, confirmation of diagnosis, and intervention is essential. PAH may be challenging to diagnose in its earliest stages, particularly in populations that have multiple causes of breathlessness, and, therefore, screening is required. The optimal screening tools and methodology are, as yet, unknown, and this is confounded by a lack of consensus over which patients to screen. Current practice favours annual screening of all SSc patients using Doppler echocardiography to detect elevated right heart pressures. This will typically identify most patients with the various forms of pulmonary hypertension found in SSc. The optimum thresholds for Doppler echocardiography are still subject to investigation, especially for patients with mild pulmonary hypertension, and this technique may, therefore, yield a significant number of false-positives and a currently unknown number of false-negatives. Confirmatory right heart catheterisation remains necessary in all suspected cases. Further research is needed to identify the optimal tools and the screening approach with greatest specificity and selectivity.

KEYWORDS: Pulmonary arterial hypertension, screening, systemic sclerosis