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DETECT Algorithm for SSc-PAH — EECC MCQ

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ModerateCardiac ImagingDETECT Algorithm for SSc-PAHEECC

A 50-year-old woman with systemic sclerosis develops progressive dyspnoea. Echocardiography shows normal LV function but elevated RA pressure. DLCO is 45% predicted (severely reduced). The DETECT algorithm score indicates high probability of PH. What is the DETECT algorithm?

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Correct answer: E — DETECT is a screening algorithm specifically designed for systemic sclerosis patients to identify PAH early using clinical variables, blood tests (NT-proBNP, urate), ECG, and DLCO to determine who should proceed to RHC — it has higher sensitivity than echocardiography alone for detecting early PAH in SSc

The DETECT algorithm (2014) was developed specifically for PAH screening in systemic sclerosis (SSc). SSc-PAH affects 8-12% of SSc patients and carries worse prognosis than IPAH. Early detection improves outcomes (treatment at lower PVR = better response). The DETECT algorithm uses a two-step approach: Step 1 (non-echocardiographic): FVC/DLCO ratio, anti-centromere antibodies, serum urate, NT-proBNP, ECG (right axis deviation); Step 2 (echocardiographic): RA area, TR velocity. It calculates a probability score determining who should proceed to RHC. DETECT has higher sensitivity (96%) than echocardiography alone (71%) for detecting PAH in SSc, reducing missed diagnoses. The ESC/ERS 2022 PH Guidelines recommend annual screening in SSc (DETECT or echocardiography-based approach) to enable early diagnosis and treatment.

Reference: ESC/ERS (2022): PH Guidelines; DETECT Algorithm