Application of the DETECT algorithm in a cohort of patients with systemic sclerosis

Abstract

Background

Pulmonary hypertension (PH) is a severe complication of systemic sclerosis (SSc), with significant prognostic implications. The DETECT algorithm, is a two-step tool developed to facilitate early PH identification in high-risk SSc patients, although its performance in routine clinical practice, especially among patients with relatively preserved diffusing capacity for carbon monoxide (DLCO) remains underexplored.

Objective

To evaluate the clinical performance of the DETECT algorithm in a real-world cohort of SSc patients without a prior diagnosis of PH, and to identify variables associated with PH in this population.

Methods

We conducted a cross-sectional study including SSc patients meeting ACR/EULAR 2013 criteria. Patients with known PH, advanced chronic kidney disease, or severe heart failure were excluded. The DETECT algorithm was applied prospectively. Right heart catheterization (RHC) was performed in patients who met Step 2 criteria. Clinical, laboratory, functional and echocardiographic variables were collected. Logistic regression analyses were conducted to identify factors independently associated with PH.

Results

85 patients with SSc were included (90.58% women; mean age 67.36 ± 11.75 years; mean disease duration 15.69 ± 9.17 years). 31 patients (36.47%) met criteria for transthoracic echocardiography (TTE), and 21 (24.70%) underwent RHC. PH was confirmed in 11 patients (12.94%). Higher tricuspid regurgitation velocity (TRV) (OR = 11.57; 95% CI: 1.29–103.98; p = 0.029) was independently associated with PH. Conversely, higher DLCO was inversely associated with PH (OR = 0.887; 95% CI: 0.797–0.987; p = 0.028). PH was detected even in patients with DLCO > 60%.

Conclusion

The DETECT algorithm is a valuable tool for PH screening in SSc patients, with good correlation between its components and confirmed PH. Its applicability may be relevant even in patients with DLCO > 60%, broadening its clinical utility. Further research is warranted to validate its performance across diverse populations and to evaluate its long-term prognostic impact.