Performance of DETECT PAH algorithm according to the hemodynamic definition of pulmonary arterial hypertension (PAH) in the 2022 ESC/ERS guidelines: Early detection of pulmonary arterial hypertension in systemic sclerosis patients.

OBJECTIVE:The evidence-based DETECT pulmonary arterial hypertension (PAH) algorithm is frequently used in systemic sclerosis (SSc) patients to help clinicians screen for PAH by using non-invasive data to recommend patient referral to echocardiography, and if applicable, for a diagnostic right heart catheterization (RHC). However, the hemodynamic definition of PAH was recently updated in the 2022 ESC/ERS guidelines. The performance of DETECT PAH in identifying patients with a high risk of PAH according to this new definition was assessed. METHODS:In this post-hoc analysis of DETECT, which comprised 466 SSc patients the performance of the DETECT PAH algorithm in identifying patients with a high risk of PAH as defined in the 2022 ESC/ERS guidelines (mean pulmonary arterial pressure [mPAP] >20 mmHg, pulmonary capillary wedge pressure [PCWP] ≤15 mmHg, pulmonary vascular resistance [PVR] >2 Wood Units was assessed using summary statistics and was descriptively compared to the known performance of DETECT PAH as defined in 2014 when it was developed (mPAP ≥25 mmHg and PCWP ≤15 mmHg). RESULTS:The sensitivity of DETECT PAH in identifying patients with a high risk of PAH according to the 2022 ESC/ERS definition was lower (88.2%) compared to the 2014 definition (95.8%). Specificity improved from 47.8% to 50.8%. CONCLUSION:The performance of the DETECT algorithm to screen for PAH in SSc patients is maintained when PAH is defined according to the 2022 ESC/ERS hemodynamic definition, indicating that DETECT remains applicable to screen for PAH in SSc patients.