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Eur Respir J. 2017 Oct 19;50(4). pii: 1701008. doi: 10.1183/13993003.01008-2017. Print 2017 Oct.

Combined measurement of carbon monoxide and nitric oxide lung transfer does not improve the identification of pulmonary hypertension in systemic sclerosis.

Author information

1
EA 3920, Université de Franche-Comté, Besançon, France bruno.degano@univ-fcomte.fr.
2
Service d'Explorations Fonctionnelles Respiratoires, CHRU de Besançon, Besançon, France.
3
Service de Médecine Interne, CHU de Poitiers, Poitiers, France.
4
Service d'Explorations Fonctionnelles Respiratoires, CHU de Bordeaux, Pessac, France.
5
Service d'Explorations Fonctionnelles Respiratoires, CHU de Lille, Lille, France.
6
EA 3920, Université de Franche-Comté, Besançon, France.
7
Service de Médecine Interne, CHU de Bordeaux, Pessac, France.
8
Dépt de Médecine Interne et Immunologie Clinique, CHU de Lille, Lille, France.
9
Lille Inflammation Research International Center (LIRIC), U995, Université de Lille, Lille, France.
10
Service de Médecine Interne, CHRU de Besançon, Besançon, France.
11
Service de Médecine Interne, Centre de Compétence Maladies Systémiques et Auto-immunes Rares, CHU de Nantes, Nantes, France.
12
Service de Médecine Interne, Hôpital Saint Antoine, Université Pierre et Marie Curie, Paris, France.
13
Service de Physiologie Respiratoire, Hôpital Cochin, Université Paris Descartes, Paris, France.
14
Service de Physiologie Digestive, Urinaire, Respiratoire et Sportive, CHU de Rouen, Rouen, France.
15
Service d'Explorations Fonctionnelles Respiratoires and équipe ALIVE (CIC 1402), CHU de Poitiers, Poitiers, France.
16
Institut du Thorax, CHU de Nantes, Nantes, France.
17
These two authors contributed equally to this work.

Abstract

Screening is important to determine whether patients with systemic sclerosis (SSc) have pulmonary hypertension because earlier pulmonary hypertension treatment can improve survival in these patients. Although decreased transfer factor of the lung for carbon monoxide (TLCO) is currently considered the best pulmonary function test for screening for pulmonary hypertension in SSc, small series have suggested that partitioning TLCO into membrane conductance (diffusing capacity) for carbon monoxide (DMCO) and alveolar capillary blood volume (VC) through combined measurement of TLCO and transfer factor of the lung for nitric oxide (TLNO) is more effective to identify pulmonary hypertension in SSc patients compared with TLCO alone. Here, the objective was to determine whether combined TLCO-TLNO partitioned with recently refined equations could more accurately detect pulmonary hypertension than TLCO alone in SSc.For that purpose, 572 unselected consecutive SSc patients were retrospectively recruited in seven French centres.Pulmonary hypertension was diagnosed with right heart catheterisation in 58 patients. TLCO, TLNO and VC were all lower in SSc patients with pulmonary hypertension than in SSc patients without pulmonary hypertension. The area under the receiver operating characteristic curve for the presence of pulmonary hypertension was equivalent for TLCO (0.82, 95% CI 0.79-0.85) and TLNO (0.80, 95% CI 0.76-0.83), but lower for VC (0.75, 95% CI 0.71-0.78) and DMCO (0.66, 95% CI 0.62-0.70).Compared with TLCO alone, combined TLCO-TLNO does not add capability to detect pulmonary hypertension in unselected SSc patients.

PMID:
29051271
DOI:
10.1183/13993003.01008-2017
[Indexed for MEDLINE]
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