Abstract Background/Aims Pulmonary hypertension (PH) is a serious and potentially fatal complication of scleroderma spectrum disorders (SSD), contributing significantly to morbidity and mortality. Current screening methods, including echocardiography and pulmonary function testing, may yield inconsistent results and risk delayed or missed diagnoses. The DETECT algorithm has been developed to improve early identification of pulmonary arterial hypertension (PAH) in this patient group and is recommended in the 2022 ESC/ERS guidelines for PAH screening in systemic sclerosis. This study aimed to evaluate the retrospective application of the DETECT algorithm in clinical practice at a single centre. Specifically, it assessed its utility in identifying patients requiring echocardiography at step one and determining eligibility for right heart catheterisation (RHC) at step two. The study also explored the role of a multidisciplinary clinic model—integrating rheumatology and pulmonary hypertension specialists—in refining the selection of patients for RHC. Methods A retrospective review was conducted of 204 patients with SSD managed at the Rheumatology Department, Queen Alexandra Hospital, Portsmouth, between January 2022 and November 2024. Diagnoses included limited and diffuse systemic sclerosis, mixed connective tissue disease with scleroderma features, overlap syndromes, undifferentiated connective tissue disease, and morphea. Data collected included demographics, clinical characteristics, diffusion capacity (TLCO), forced vital capacity (FVC), uric acid, NT-proBNP, and ECG findings. DETECT screening criteria were retrospectively applied, and patients meeting step two thresholds were reviewed in a dedicated combined clinic to determine suitability for RHC. Results Out of 204 patients reviewed, 29 were eligible for DETECT screening. Following the application of Steps 1 and 2 of the DETECT algorithm, 14 patients were identified as eligible for right heart catheterisation (RHC). These patients were subsequently assessed in the Scleroderma Pulmonary Hypertension Clinic, where further evaluations allowed for better differentiation among types of pulmonary hypertension and determination of RHC suitability. A 7% prevalence of scleroderma pulmonary arterial hypertension (PAH) was observed at Queen Alexandra Hospital, aligning with published data reporting prevalence rates between 7% and 12%. Among the 14% of patients eligible for DETECT screening, 48% were positive for scleroderma PAH. A limitation was the study’s retrospective design, which introduces potential survivorship bias, as it involves a treated cohort. Conclusion In a large secondary care cohort, retrospective application of the DETECT algorithm demonstrated good diagnostic yield and aligned with reported PAH prevalence in systemic sclerosis. Integrating DETECT into a multidisciplinary care pathway optimises screening, reduces unnecessary echocardiography and invasive procedures, and enables earlier detection of milder disease. The DETECT tool improves the overall management and outcomes for systemic sclerosis patients at risk of pulmonary hypertension. Disclosure C. Ramakrishna: None. T. Nasrin: None. A. Scott-Russell: None. D. Knight: None. L. Parker: None.
Ramakrishna et al. (Wed,) studied this question.