RT Journal Article
SR Electronic
T1 Prevalence of Exercise Pulmonary Arterial Hypertension in Scleroderma
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 1812
OP 1816
VO 35
IS 9
A1 JOSE LUIS CALLEJAS-RUBIO
A1 EDUARDO MORENO-ESCOBAR
A1 PILAR MARTÍN de la FUENTE
A1 LOURDES LÓPEZ PÉREZ
A1 RAQUEL RIOS FERNÁNDEZ
A1 DANIEL SÁNCHEZ-CANO
A1 JOSÉ POMARES MORA
A1 NORBERTO ORTEGO-CENTENO
YR 2008
UL http://www.jrheum.org/content/35/9/1812.abstract
AB Objective Pulmonary arterial hypertension (PAH) is a complication of scleroderma (systemic sclerosis, SSc); as soon as PAH develops, the patient’s prognosis deteriorates rapidly. Early detection of PAH ensures timely treatment. We investigated the prevalence of exercise-induced PAH in a cohort of patients with SSc, and examined the relation between exercise-induced PAH and clinical characteristics and biochemical markers. Methods Patients with SSc and normal resting systolic pulmonary arterial pressure (sPAP) were studied. Eligible patients were asked to perform cycloergometer exercise until exhaustion, and exercise sPAP was measured. All patients had their pulmonary function tested and underwent echocardiography at rest. Brain natriuretic peptide (BNP) was also determined. Results Forty-one patients with SSc were studied. Mean sPAP at rest was 29.7 mm Hg, rising to a mean of 41.4 mm Hg on exercise. Eleven of 41 patients (26.8%) had sPAP post-exercise > 50 mm Hg and 8/41 (19.5%) > 55 mm Hg. A significant correlation was found between exercise sPAP and DLCO (p = 0.008) and between sPAP and BNP levels (p = 0.04). Pre-existing severe Raynaud’s phenomenon was more prevalent (50% vs 20%), DLCO levels lower (78.9 vs 92.7 % predicted), and BNP levels higher (72.6 vs 42.1 pmol/ml) in patients with exercise sPAP > 55 mm Hg. Conclusion The prevalence of exercise-induced PAH in patients with scleroderma is high. Patients with lower DLCO and higher levels of BNP are at higher risk of developing higher sPAP. Studies with longterm followup are required to evaluate the risk of developing resting PAH in these patients.