For scleroderma, algorithm helps better screen for fatal complication

Photo credit: University of Michigan

Screening for a sometimes fatal condition in patients with a rare autoimmune disease could soon become even more accurate thanks to a computer algorithm.

Michigan Medicine researchers found that an internet application improved their ability to detect pulmonary arterial hypertension in patients with systemic sclerosis or scleroderma. The unpredictable condition is characterized by a tightening of the skin, which can damage the internal organs.

The algorithm, aptly named DETECT, outperformed standard methods of identifying the form of high blood pressure in the lungs that causes the heart to weaken and fail.

“We have long advocated that every scleroderma patient be screened annually with DETECT, and these data support that,” says Dinesh Khanna, MBBS, M.Sc., study lead author and director of Michigan Medicine’s Scleroderma Program. “Pulmonary arterial hypertension is one of the leading causes of death for these patients and we want to diagnose it early.”

The DETECT algorithm is a two-step algorithm that uses six different clinical variables to determine whether a patient needs an echocardiogram or an ultrasound of the heart. The second step then informs you whether the patient should be referred for right heart catheterization.

The researchers found that the algorithm correctly identified all 10 patients with pulmonary arterial hypertension in a study of 68 subjects.

“It didn’t miss a single patient; it couldn’t be better,” says Khanna. “This is a very sensitive screening tool and can be very useful.”

However, of the times DETECT detected signs of pulmonary hypertension during the study, only 20% of patients with right heart catheterizations actually suffered from the debilitating condition. Khanna says it is better to be careful.

“That’s the trade-off between such a sensitive test,” he says. “Right heart catheterization is invasive, but because of the mortality of [pulmonary arterial hypertension] is so high and prevalence is so high that the benefits outweigh the risks. “

Around 10% of patients with scleroderma, which affects around 70,000 people each year in the United States, develop pulmonary hypertension. Under current guidelines, doctors who screen scleroderma patients for the condition observe an annual echocardiogram.

While it’s an effective diagnostic tool for symptomatic patients, the ultrasound scans don’t accurately predict the condition in asymptomatic people or at the onset of the disease, says Khanna. This inaccuracy motivated both him and lead researcher and rheumatologist Amber Young, MD to conduct the study.

“About every third patient who may have pulmonary arterial hypertension is absent from these ultrasound exams,” he says. “And if we diagnose a patient this late, the story is over – the patient will likely die in the next two or three years,” he says.

This study was the first to compare the algorithm to the echocardiogram guidelines published in 2015. The research team hopes more doctors will consider using DETECT to help treat the complication earlier. And Khanna expects more studies to conclude with similar recommendations.

“I’m sure people all over the world will do and validate this work,” says Khanna. “Early diagnosis and treatment of pulmonary arterial hypertension will lead to better outcomes, including improved quality of life and improved survival in people with scleroderma.”

The new virtual screening tool facilitates and accelerates the routine diagnosis of pulmonary hypertension

More information:
Amber Young et al., Performance of the DETECT Algorithm for Screening for Pulmonary Hypertension in a Cohort for Systemic Sclerosis, Arthritis, and Rheumatology (2021). DOI: 10.1002 / art.41732 Provided by the University of Michigan

Quote: In scleroderma, the algorithm helps to better check for fatal complications (2021, April 21), published on April 21, 2021 from complication.html

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