Electrocardiographic detection of pulmonary hypertension in patients with systemic sclerosis using the ventricular gradient

• Pulmonary hypertension (PH) is a leading cause of death in patients with systemic sclerosis (SSc).
• The electrocardiographically derived ventricular gradient (VG-RVPO) is a novel, low cost and easy-to-use screening tool that can accurately detect right ventricular repolarisation changes caused by right ventricular overload.
• We investigated the value of the VG-RVPO to detect PH and predict all-cause mortality in PH patients with subtypes of SSc differing in the extent of multi-organ involvement.
• The VG-RVPO was significantly elevated in patients with PH and limited SSc compared to patients without PH.
• The VG-RVPO correlated well with conventional PH screening parameters and had a better diagnostic performance than the presence of a right heart axis in patients with limited SSc.
• An elevated VG-RVPO was associated with decreased survival in SSc patients with PH.

BackgroundPulmonary hypertension (PH) is a leading cause of death in systemic sclerosis (SSc) patients. The current study assessed the ability of the ECG-derived ventricular gradient (VG-RVPO) to detect PH and predict all-cause mortality in PH patients with subtypes of SSc differing in the extent of multi-organ involvement.MethodsECGs were obtained from 196 patients with limited and 77 patients with diffuse SSc included from our screening programme on cardiac complications. The association of the VG-RVPO with (1) the presence of PH, (2) conventional screening parameters and (3) survival in PH patients was assessed.ResultsIn limited SSc patients an elevated VG-RVPO corresponded with the presence of PH (− 5 ± 12 mV.ms vs − 22 ± 16 mV.ms, P < 0.01), correlated significantly with conventional screening parameters and had a better diagnostic performance than the presence of a right heart axis (AUC 0.81 vs 0.60; P = 0.04). These differences were not observed in patients with diffuse SSc. An elevated VG-RVPO was associated with decreased survival in all SSc patients with PH (3 year survival 30% vs 64%, P = 0.02).ConclusionAn elevated VG-RVPO is associated with PH in limited SSc patients and with decreased survival in all SSc patients with PH.