Advertisement

Lung

, Volume 196, Issue 2, pp 173–178 | Cite as

Pulmonary Arterial Hemodynamic Assessment by a Novel Index in Systemic Sclerosis Patients: Pulmonary Pulse Transit Time

  • Mehmet Dogan
  • Tolga Han Efe
  • Tolga Cimen
  • Cem Ozisler
  • Mehmet Ali Felekoglu
  • Ahmet Goktug Ertem
  • Mehmet Erat
  • Omer Yiginer
  • Murat Tulmac
PULMONARY HYPERTENSION
  • 122 Downloads

Abstract

Objectives

Systemic sclerosis (SSc) is a chronic, inflammatory, and autoimmune connective tissue disease that is associated with vascular lesions, and fibrosis of the skin and visceral organs. Cardiac complications may occur as a secondary effect of SSc as a result of pulmonary arterial hypertension and interstitial lung disease. The objective of this study was to assess whether the pulmonary pulse transit time (pPTT) could serve as a diagnostic marker for pulmonary arterial alterations in patients with SSc, prior to development of pulmonary hypertension.

Methods

Twenty-five SSc patients as a study group and 25 age- and sex-matched healthy volunteers for the control group were recruited to the study. Right ventricle function parameters, such as tricuspid annular plane systolic excursion (TAPSE), estimated pulmonary artery systolic pressure (ePASP), right ventricular dimensions, right ventricle fractional area changes, and myocardial perfusion index (MPI) were measured and calculated. Pulmonary pulse transit time was defined as the time interval between the R-wave peak in the ECG and the corresponding peak late systolic pulmonary vein flow velocity.

Results

Right ventricle myocardial performance index (RVMPI) and eSPAP were significantly higher in the SSc group than the controls (p = 0.032, p = 0.012, respectively). Pulmonary pulse transit time and TAPSE was shorter in the patients with SSc (p = 0.006, p = 0.015, respectively). In correlation analysis, pPTT was inversely correlated with RVMPI (r = − 0.435, p = 0.003), eSPAP (r = − 0.434, p = 0.003), and disease duration (r = − 0.595, p = 0.003). Conversely, it positively correlated with TAPSE (r = 0.345, p = 0.022).

Conclusion

pPTT was found to be shorter in SSc patients. pPTT might serve as a surrogate marker of pulmonary hemodynamics in patients with SSc, even prior to the development of pulmonary hypertension.

Keywords

Systemic sclerosis Pulmonary pulse transit time Pulmonary hypertension 

Notes

Compliance with Ethical Standards

Conflict of interest

There is no financial or other relationship that might be perceived as leading to a conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Giunta A et al (2000) Right ventricular diastolic abnormalities in systemic sclerosis. Relation to left ventricular involvement and pulmonary hypertension. Ann Rheum Dis 59(2):94–98CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Steen VD, Medsger TA Jr (2000) Severe organ involvement in systemic sclerosis with diffuse scleroderma. Arthritis Rheum 43(11):2437–2444CrossRefPubMedGoogle Scholar
  3. 3.
    Schattke S et al (2010) Early right ventricular systolic dysfunction in patients with systemic sclerosis without pulmonary hypertension: a Doppler tissue and speckle tracking echocardiography study. Cardiovasc Ultrasound 8:3CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Kahan A, Coghlan G, McLaughlin V (2009) Cardiac complications of systemic sclerosis. Rheumatology.  https://doi.org/10.1093/rheumatology/kep110.Google Scholar
  5. 5.
    Galie N et al (2016) 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and. the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J 37(1):67–119CrossRefPubMedGoogle Scholar
  6. 6.
    Steen VD, Medsger TA (2007) Changes in causes of death in systemic sclerosis, 1972–2002. Ann Rheum Dis 66(7):940–944CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Launay D et al (2013) Survival in systemic sclerosis-associated pulmonary arterial hypertension in the modern management era. Ann Rheum Dis 72(12):1940–1946CrossRefPubMedGoogle Scholar
  8. 8.
    Meune C et al (2004) High prevalence of right ventricular systolic dysfunction in early systemic sclerosis. J Rheumatol 31(10):1941–1945PubMedGoogle Scholar
  9. 9.
    Mukerjee D et al (2003) Prevalence and outcome in systemic sclerosis associated pulmonary arterial hypertension: application of a registry approach. Ann Rheum Dis 62(11):1088–1093CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Sanz J et al (2009) Evaluation of pulmonary artery stiffness in pulmonary hypertension with cardiac magnetic resonance. JACC Cardiovasc Imaging 2(3):286–295CrossRefPubMedGoogle Scholar
  11. 11.
    Gan CT et al (2007) Noninvasively assessed pulmonary artery stiffness predicts mortality in pulmonary arterial hypertension. Chest 132(6):1906–1912CrossRefPubMedGoogle Scholar
  12. 12.
    Smith RP et al (1999) Pulse transit time: an appraisal of potential clinical applications. Thorax 54(5):452–457CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Wibmer T et al (2015) Pulmonary pulse transit time: a novel echocardiographic indicator of hemodynamic and vascular alterations in pulmonary hypertension and pulmonary fibrosis. Echocardiography 32(6):904–911CrossRefPubMedGoogle Scholar
  14. 14.
    Kepez A et al (2008) Detection of subclinical cardiac involvement in systemic sclerosis by echocardiographic strain imaging. Echocardiography 25(2):191–197CrossRefPubMedGoogle Scholar
  15. 15.
    Preliminary criteria for the classification of systemic sclerosis (scleroderma). Subcommittee for scleroderma criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Committee (1980) Arthritis Rheum 23(5):581–590Google Scholar
  16. 16.
    Quinones MA et al (2002) Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr 15(2):167–184CrossRefPubMedGoogle Scholar
  17. 17.
    MacGregor AJ et al (2001) Pulmonary hypertension in systemic sclerosis: risk factors for progression and consequences for survival. Rheumatology 40(4):453–459CrossRefPubMedGoogle Scholar
  18. 18.
    Steen V, Medsger TA Jr (2003) Predictors of isolated pulmonary hypertension in patients with systemic sclerosis and limited cutaneous involvement. Arthritis Rheum 48(2):516–522CrossRefPubMedGoogle Scholar
  19. 19.
    Kawut SM et al (2003) Hemodynamics and survival in patients with pulmonary arterial hypertension related to systemic sclerosis. Chest 123(2):344–350CrossRefPubMedGoogle Scholar
  20. 20.
    Gaine SP, Rubin LJ (1998) Primary pulmonary hypertension. Lancet 352(9129):719–725CrossRefPubMedGoogle Scholar
  21. 21.
    Durmus E et al (2015) Right ventricular and atrial functions in systemic sclerosis patients without pulmonary hypertension. Speckle-tracking echocardiographic study. Herz 40(4):709–715CrossRefPubMedGoogle Scholar
  22. 22.
    Forfia PR et al (2006) Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Respir Crit Care Med 174(9):1034–1041CrossRefPubMedGoogle Scholar
  23. 23.
    Miller D et al (2004) The relation between quantitative right ventricular ejection fraction and indices of tricuspid annular motion and myocardial performance. J Am Soc Echocardiogr 17(5):443–447CrossRefPubMedGoogle Scholar
  24. 24.
    Tannus-Silva DG et al (2016) Myocardial performance index correlates with the BODE index and affects quality of life in COPD patients. Int J Chron Obstruct Pulmon Dis 11:2261–2268CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Mahapatra S et al (2006) Relationship of pulmonary arterial capacitance and mortality in idiopathic pulmonary arterial hypertension. J Am Coll Cardiol 47(4):799–803CrossRefPubMedGoogle Scholar
  26. 26.
    Wang Z, Chesler NC (2011) Pulmonary vascular wall stiffness: an important contributor to the increased right ventricular afterload with pulmonary hypertension. Pulm Circ 1(2):212–23CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Champion HC, Michelakis ED, Hassoun PM (2009) Comprehensive invasive and noninvasive approach to the right ventricle-pulmonary circulation unit: state of the art and clinical and research implications. Circulation 120(11):992–1007CrossRefPubMedGoogle Scholar
  28. 28.
    Kopec G et al (2013) Pulmonary artery pulse wave velocity in idiopathic pulmonary arterial hypertension. Can J Cardiol 29(6):683–690CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of CardiologyMedipol University HospitalIstanbulTurkey
  2. 2.Department of CardiologyDiskapi Yildirim Beyazit Training and Research HospitalAnkaraTurkey
  3. 3.Department of RheumatologyDiskapi Yildirim Beyazit Training and Research HospitalAnkaraTurkey
  4. 4.Department of CardiologyDr. Ersin Aslan Training and Research HospitalGaziantepTurkey
  5. 5.Department of CardiologyTürkiye Yüksek Ihtisas Training and Research HospitalAnkaraTurkey
  6. 6.Department of CardiologyBahcesehir University HospitalIstanbulTurkey

Personalised recommendations