Background: Pulmonary hypertension (PH) is one of the most critical organ involovement in rheumatic and musculoskeletal diseases. The threshold for the diagnosis of PH is defined as 20 mmHg of a mean pulmonary arterial pressure (mPAP) with right heart catherterization (RHC) [1]. The definition of pulmonary hypertension has been updated from a mean pulmonary arterial pressure (mPAP) of 25 mmHg to 20 mmHg, aiming for a better long-term prognosis. However, it is still difficult to predict patients with PH through non-invasive findings.

Objectives: To identify predictive factors for early PH diagnosis in patients with rheumatic and musculoskeletal diseases.

Methods: We reviewed consecutive patients with rheumatic and musculoskeletal diseases who underwent RHC from December 2020 to May 2023. Right heart catheterization was performed who showed tricuspid regurgitation pressure gradient (TRPG) was ≥ 30 mmHg with signs of right heart overload in transthoracic echocardiography. PH was diagnosed based on mPAP > 20mmHg with RHC. We divided the patients into two groups according to the presence of PH and compared their clinical characteristics.

Results: Thirty-nine patients including 14 with overlap syndrome, 7 with mix connective tissue disease, 9 with systemic sclerosis, 2 with systemic lupus erythematosus, 1 with Sjögren syndrome, and 6 with others were included in the analysis. Among them, 22 (56.4%) patients were diagnosed as having PH. Patients with PH showed significantly higher TRPG (48.4 mmHg vs 31.3mmHg, p=0.0004), lower saturation of percutaneous oxygen (SpO2) in 6-min walk test (6MWT) (86.7% vs 90.5%, p= 0.0421), and higher positive rate for anti-SSA antibody (66.7% vs 21.3%, p= 0.0489). A receiver operating characteristic curve identified 33.5 mmHg as a cut-off value of TRPG and 90% of lowest SpO2 in 6MWT to discriminate patients with PH from those without. Compared to evaluation using TRPG alone (sensitivity of 86.4% and a specificity of 76.5%), using TRPG in combination with either 6MWT or anti-SSA yielded higher specificity (sensitivity 82.4%, specificity 92.3%).

Conclusion: TRPG higher than 33.5 mmHg with transthoracic echocardiography, SpO2 lower than 90% in the 6MWT, and anti-SSA positivity can predict the presence of PH in patients with rheumatic and musculoskeletal diseases.

REFERENCES: [1] European heart journal 43.38 (2022): 3618-3731.

Acknowledgements: NIL.

Disclosure of Interests: None declared.