Lung Involvements in Rheumatic Diseases: Update on the Epidemiology, Pathogenesis, Clinical Features, and Treatment

Table 2

Recommendations for right heart catheterization for SSc and SSc-spectrum disorder.

Modalities	Parameter thresholds required for RHC	Signs/ required for RHC
Echocardiography	TR velocity
	2.5–2.8 m/s	Yes
	>2.8 m/s	No
	Cavity enlargements irrespective of TR velocity	No
	Right atrial major dimension > 53 mm or
	Right ventricular mid-cavity dimension > 35 mm
Pulmonary function tests	FVC/DLCO ratio > 1.6 and/or DLCO < 60%	Yes
	FVC/DLCO ratio > 1.6 and/or DLCO < 60% and NT-pro BNP > 2 times upper limit of	No
Composite measures	Meets DETECT algorithm in patients with DLCO < 60% and disease duration of >3 years from 1st non-Raynaud’s symptom	No

: dyspnea on rest or exercise, fatigue, presyncope/syncope, chest pain, palpitations, dizziness, and lightheadedness. Signs: loud pulmonic sound and peripheral edema. overt systolic dysfunction, greater than grade I diastolic dysfunction or greater than mild mitral or aortic valve disease, or evidence of PAH in echocardiography; DLCO: diffusing capacity of carbon monoxide; FVC: forced vital capacity; NT-proBNP: N-terminal probrain natriuretic peptide; PAH: pulmonary arterial hypertension; SSc: systemic sclerosis; TR: tricuspid regurgitation (cited and modified from “Recommendations for Screening and Detection of Connective Tissue Disease-Associated Pulmonary Arterial Hypertension” by D. Khanna, C. H. Tseng, N. Farmani et al. Arthritis Rheum 2013; 65: 3194-201).