A comparison of the predictive accuracy of three screening models for pulmonary arterial hypertension in systemic sclerosis

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dc.contributor.authorHao, Y.
dc.contributor.authorThakkar, V.
dc.contributor.authorStevens, W.
dc.contributor.authorMorrisroe, K.
dc.contributor.authorPrior, D.
dc.contributor.authorRabusa, C.
dc.contributor.authorYoussef, P.
dc.contributor.authorGabbay, E.
dc.contributor.authorRoddy, J.
dc.contributor.authorWalker, J.
dc.contributor.authorZochling, J.
dc.contributor.authorSahhar, J.
dc.contributor.authorNash, P.
dc.contributor.authorLester, S.
dc.contributor.authorRischmueller, M.
dc.contributor.authorProudman, S.M.
dc.contributor.authorNikpour, M.
dc.date.issued2015
dc.description.abstractINTRODUCTION: There is evidence that early screening for pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) improves outcomes. We compared the predictive accuracy of two recently published screening algorithms (DETECT 2013 and Australian Scleroderma Interest Group (ASIG) 2012) for SSc-associated PAH (SSc-PAH) with the commonly used European Society of Cardiology/European Respiratory Society (ESC/ERS 2009) guidelines. METHODS: We included 73 consecutive SSc patients with suspected PAH undergoing right heart catheterization (RHC). The three screening models were applied to each patient. For each model, contingency table analysis was used to determine sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values for PAH. These properties were also evaluated in an 'alternate scenario analysis' in which the prevalence of PAH was set at 10%. RESULTS: RHC revealed PAH in 27 (36.9%) patients. DETECT and ASIG algorithms performed equally in predicting PAH with sensitivity and NPV of 100%. The ESC/ERS guidelines had sensitivity of 96.3% and NPV of only 91%, missing one case of PAH; these guidelines could not be applied to three patients who had absent tricuspid regurgitant (TR) jet. The ASIG algorithm had the highest specificity (54.5%). With PAH prevalence set at 10%, the NPV of the models was unchanged, but the PPV dropped to less than 20%. CONCLUSIONS: In this cohort, the DETECT and ASIG algorithms out-perform the ESC/ERS guidelines, detecting all patients with PAH. The ESC/ERS guidelines have limitations in the absence of a TR jet. Ultimately, the choice of SSc-PAH screening algorithm will also depend on cost and ease of application.
dc.description.statementofresponsibilityYanjie Hao, Vivek Thakkar, Wendy Stevens, Kathleen Morrisroe, David Prior, Candice Rabusa, Peter Youssef, Eli Gabbay, Janet Roddy, Jennifer Walker, Jane Zochling, Joanne Sahhar, Peter Nash, Susan Lester, Maureen Rischmueller, Susanna M Proudman, and Mandana Nikpour
dc.identifier.citationArthritis Research & Therapy, 2015; 17(1):23-23
dc.identifier.doi10.1186/s13075-015-0517-5
dc.identifier.issn1478-6362
dc.identifier.issn1478-6362
dc.identifier.orcidLester, S. [0000-0003-3013-2701]
dc.identifier.orcidRischmueller, M. [0000-0001-5057-3286]
dc.identifier.orcidProudman, S.M. [0000-0002-3046-9884]
dc.identifier.urihttp://hdl.handle.net/2440/97399
dc.language.isoen
dc.publisherBioMed Central
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1071735
dc.rights© 2015 Hao et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
dc.source.urihttps://doi.org/10.1186/s13075-015-0517-5
dc.subjectHumans
dc.subjectHypertension, Pulmonary
dc.subjectScleroderma, Systemic
dc.subjectMass Screening
dc.subjectCohort Studies
dc.subjectPredictive Value of Tests
dc.subjectAlgorithms
dc.subjectAged
dc.subjectMiddle Aged
dc.subjectFemale
dc.subjectMale
dc.titleA comparison of the predictive accuracy of three screening models for pulmonary arterial hypertension in systemic sclerosis
dc.typeJournal article
pubs.publication-statusPublished

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