Editorial commentary

I read the interesting study evaluating "Assessment of Pulmonary Arterial Stiffness in Patients with Systemic Sclerosis without Overt Pulmonary Hypertension" by Coksevim et al. It is very well known that the development of pulmonary hypertension noticeably increases morbidity and mortality in all conditions [1]. Considering the incidence of pulmonary hypertension associated with connective tissue diseases (CTD), especially in patients with systemic sclerosis, the impact of early diagnosis and treatment on prognosis in this patient group is obvious [2]. All scientific efforts to be made in this context are significant.

In patients with systemic sclerosis, a diagnosis of pulmonary hypertension can be made within 10–15 years from the time of diagnosis [3]. Current guidelines recommend annual screening with echocardiography in patients who do not develop overt pulmonary hypertension, but no specific treatment is recommended unless overt pulmonary hypertension develops. Parameters such as peak tricuspid regurgitation velocity, right atrial area, tissue doppler RV-MPI, or PAS can be used as predictors for the development of pulmonary hypertension [4].

Increased PAS values have determined impaired pulmonary distensibility in many clinical studies [5,6,7]. For instance, Cerik et al. found significantly higher PAS values in HIV (+) patients than in HIV (−) patients [5]. Likewise, Baysal et al. also obtained similar findings in newly diagnosed asthma patients [6].

In their cross-sectional study, Coksevim et al. found a significant increase in PAS value in patients with systemic sclerosis compared to the healthy control group. They also revealed that the impairment in PAS value showed a positive correlation with the duration of the disease. However, since prospective follow-up of these patients could not be performed, it could not be mentioned which PAS value was predictive for the development of pulmonary hypertension.

The gold standard method for PAS measurement is right heart catheterization. There are studies that compare MRI and RCH in the literature and the results are similar [8]. However, these methods can be used very limitedly in clinical practice because they are not easily applicable and accessible. Measuring PAS in a more accessible and easy way with echocardiography is promising for the future. Echocardiographically evaluated PAS was defined as the ratio between the pulmonary flow maximum frequency shift (MFS) and the pulmonary flow acceleration time (PAT). These parameters can be easily measured during standard transthoracic echocardiography.

It is obvious that prospective follow-up studies are needed to demonstrate the clinical significance of echocardiographically measured PAS. However, in the light of current data, PAS draws attention as a promising parameter for the development of pulmonary hypertension in risky patient populations.