Chest
Original ResearchReduced Exercise Capacity and Stress-Induced Pulmonary Hypertension in Patients With Scleroderma
Section snippets
Patients
The study included consecutive patients from February 2003 to April 2004 18 years old with a rheumatologist-established diagnosis of scleroderma by standard criteria.15 Patients were referred as part of their routine follow-up care. Both, patients with diffuse systemic sclerosis or limited scleroderma (CREST syndrome [calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia]) were accepted. PASP was normal or only mildly elevated at rest (PASP ≤ 35 mm Hg plus
Results
All patients had normal wall motion at baseline. There were no clinical signs of heart failure on physical examination. The vast majority of patients had no left ventricular hypertrophy. Diabetes (n = 1) and hypertension (n = 6) were infrequent. Resting diastolic function was normal (Table 1). Pulmonary function data were available for 57 patients (87%; Table 1). Right atrial pressure was estimated at 5 mm Hg for all patients. No patients complained of exertional chest pain. Thirty patients
Discussion
In this study, we demonstrate that stress-induced pulmonary systolic hypertension in patients with scleroderma is highly prevalent, and is associated with reduced exercise capacity, decreased maximum cardiac workload, and decreased adjusted Dlco. While our data do not directly examine the mechanism underlying these relations, they do suggest that determinants of exercise capacity in scleroderma patients may vary from those variables that govern more traditional populations undergoing exercise
Acknowledgment
The authors thank Dr. Irfan Yusufzai for his assistance in data collection and management.
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2019, Advances in Medical SciencesCitation Excerpt :SSc patients often experience dyspnea with exercise. Alkotob et al. [19] and Mininni et al. [20] revealed that exercise-induced increases in TRPG on echocardiogram commonly occur in SSc, but RHC was not performed to confirm these findings. Steen et al. [12] evaluated 54 SSc patients and revealed an increase in exercise TRPG > 20 mmHg in 44% of them.
Pulmonary Circulation on the Crossroads Between the Left and Right Heart in Systemic Sclerosis: A Clinical Challenge for Cardiologists and Rheumatologists
2018, Heart Failure ClinicsCitation Excerpt :Exercise echocardiography is a noninvasive tool to estimate pulmonary hemodynamics during exercise and is useful to assess abnormalities of pulmonary vascular function as well as the state of the right heart, although it does not have an established role in the management of SSc patients. A main issue in SSc is the high percentage of patients showing exercise PH during exercise stress echocardiography, which clearly overestimates the subset of SSc patients who will develop PAH.63–66 PAP is dependent, however, not only on PVR, which is abnormally increased in PAH, but also on left atrial pressure and CO, as shown both in healthy subjects67 and in SSc.51
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Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).
Supported in part by National Institutes of Health General Clinical Research Center grant MO1RR06192.
There are no conflicts of interest or financial disclosures for any of the authors.