Medicine (St Vincent's) - Research Publications

Permanent URI for this collection

http://hdl.handle.net/11343/205

Filters

2014 - 2019 2 2020 - 2023 1
3
Reset filters

Settings
Statistics
Citations
Author: Morrisroe, Kathleen × Author: Nikpour, Mandana × Author: Prior, David × Author: Stevens, Wendy ×

Search Results

Now showing 1 - 3 of 3
  • Item
    Thumbnail Image
    Multidisciplinary team discussion: the emerging gold standard for management of cardiopulmonary complications of connective tissue disease
    Fairley, JL ; Ross, L ; Burns, A ; Prior, D ; Conron, M ; Rouse, H ; McDonald, J ; MacIsaac, A ; La Gerche, A ; Morrisroe, K ; Ferdowsi, N ; Quinlivan, A ; Brown, Z ; Stevens, W ; Nikpour, M (WILEY, 2023-10)
    Cardiopulmonary complications of connective tissue diseases (CTDs), particularly pulmonary arterial hypertension (PAH) and interstitial lung disease (ILD), are major determinants of morbidity and mortality. Multidisciplinary meetings may improve diagnostic accuracy and optimise treatment. We review the literature regarding multidisciplinary meetings in CTD-ILD and PAH and describe our tertiary centre experience of the role of the multidisciplinary meeting in managing CTD-PAH.
  • Item
    Thumbnail Image
    Survival and quality of life in incident systemic sclerosis-related pulmonary arterial hypertension
    Morrisroe, K ; Stevens, W ; Huq, M ; Prior, D ; Sahhar, J ; Ngian, G-S ; Celermajer, D ; Zochling, J ; Proudman, S ; Nikpour, M (BMC, 2017-06-02)
    BACKGROUND: Pulmonary arterial hypertension (PAH) is a leading cause of mortality in systemic sclerosis (SSc). We sought to determine survival, predictors of mortality, and health-related quality of life (HRQoL) related to PAH in a large SSc cohort with PAH. METHODS: We studied consecutive SSc patients with newly diagnosed (incident) World Health Organization (WHO) Group 1 PAH enrolled in a prospective cohort between 2009 and 2015. Survival methods were used to determine age and sex-adjusted standardised mortality ratio (SMR) and years of life lost (YLL), and to identify predictors of mortality. HRQoL was measured using the Short form 36 (SF-36) instrument. RESULTS: Among 132 SSc-PAH patients (112 female (85%); mean age 62 ± 11 years), 60 (45.5%) died, with a median (±IQR) survival time from PAH diagnosis of 4.0 (2.2-6.2) years. Median (±IQR) follow up from study enrolment was 3.8 (1.6-5.8) years. The SMR for patients with SSc-PAH was 5.8 (95% CI 4.3-7.8), with YLL of 15.2 years (95% CI 12.3-18.1). Combination PAH therapy had a survival advantage (p < 0.001) compared with monotherapy, as did anticoagulation compared with no anticoagulation (p < 0.003). Furthermore, combination PAH therapy together with anticoagulation had a survival benefit compared with monotherapy with or without anticoagulation and combination therapy without anticoagulation (hazard ratio 0.28, 95% CI 0.1-0.7). Older age at PAH diagnosis (p = 0.03), mild co-existent interstitial lung disease (ILD) (p = 0.01), worse WHO functional class (p = 0.03) and higher mean pulmonary arterial pressure at PAH diagnosis (p = 0.001), and digital ulcers (p = 0.01) were independent predictors of mortality. CONCLUSIONS: Despite the significant benefits conferred by advanced PAH therapies suggested in this study, the median survival in SSc PAH remains short at only 4 years.
  • Item
    Thumbnail Image
    A COMPARISON OF THE PREDICTIVE ACCURACY OF THREE SCREENING MODELS (DETECT V. ESC/ERS V. ASIG) FOR PULMONARY ARTERIAL HYPERTENSION IN SYSTEMIC SCLEROSIS
    Hao, Y ; Thakkar, V ; Stevens, W ; Morrisroe, K ; Prior, D ; Rabusa, C ; Youssef, P ; Gabbay, E ; Roddy, J ; Walker, J ; Zochling, J ; Sahhar, J ; Nash, P ; Lester, S ; Rischmueller, M ; Proudman, S ; Nikpour, M (WILEY-BLACKWELL, 2014-05)
    INTRODUCTION: There is evidence that early screening for pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) improves outcomes. We compared the predictive accuracy of two recently published screening algorithms (DETECT 2013 and Australian Scleroderma Interest Group (ASIG) 2012) for SSc-associated PAH (SSc-PAH) with the commonly used European Society of Cardiology/European Respiratory Society (ESC/ERS 2009) guidelines. METHODS: We included 73 consecutive SSc patients with suspected PAH undergoing right heart catheterization (RHC). The three screening models were applied to each patient. For each model, contingency table analysis was used to determine sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values for PAH. These properties were also evaluated in an 'alternate scenario analysis' in which the prevalence of PAH was set at 10%. RESULTS: RHC revealed PAH in 27 (36.9%) patients. DETECT and ASIG algorithms performed equally in predicting PAH with sensitivity and NPV of 100%. The ESC/ERS guidelines had sensitivity of 96.3% and NPV of only 91%, missing one case of PAH; these guidelines could not be applied to three patients who had absent tricuspid regurgitant (TR) jet. The ASIG algorithm had the highest specificity (54.5%). With PAH prevalence set at 10%, the NPV of the models was unchanged, but the PPV dropped to less than 20%. CONCLUSIONS: In this cohort, the DETECT and ASIG algorithms out-perform the ESC/ERS guidelines, detecting all patients with PAH. The ESC/ERS guidelines have limitations in the absence of a TR jet. Ultimately, the choice of SSc-PAH screening algorithm will also depend on cost and ease of application.