Determinants of exercise-induced pulmonary arterial hypertension in systemic sclerosis.

[en] BACKGROUND: Exercise-induced pulmonary arterial hypertension (EIPH) in systemic sclerosis (SSc) has already been observed but its determinants remain unclear. The aim of this study was to determine the incidence and the determinants of EIPH in SSc. METHODS AND RESULTS: We prospectively enrolled 63 patients with SSc (age 54+/-3years, 76% female) followed in CHU Sart-Tilman in Liege. All patients underwent graded semi-supine exercise echocardiography. Systolic pulmonary arterial pressure (sPAP) was derived from the peak velocity of the tricuspid regurgitation jet and adding the estimation of right atrial pressure, both at rest and during exercise. Resting pulmonary arterial hypertension (PH) was defined as sPAP >35mmHg and EIPH as sPAP >50mmHg during exercise. The following formulas were used: mean PAP (mPAP)=0.61xsPAP+2, left atrial pressure (LAP)=1.9+1.24xleft ventricular (LV) E/e' and pulmonary vascular resistance (PVR)=(mPAP-LAP)/LV cardiac output (CO) and slope of mPAP-LVCO relationship=changes in mPAP/changes in LVCO. Resting PH was present in 3 patients (7%) and 21 patients developed EIPH (47%). Patients with EIPH had higher resting LAP (10.3+/-2.2 versus 8.8+/-2.3mmHg; p=0.03), resting PVR (2.6+/-0.8 vs. 1.4+/-1.1Woods units; p=0.004), exercise LAP (13.3+/-2.3 vs. 9+/-1.7mmHg; p<0.0001), exercise PVR (3.6+/-0.7 vs. 2.1+/-0.9 Woods units; p=0.02) and slope of mPAP-LVCO (5.8+/-2.4 vs. 2.9+/-2.1mmHg/L/min; p<0.0001). After adjustment for age and gender, exercise LAP (beta=3.1+/-0.8; p=0.001) and exercise PVR (beta=7.9+/-1.7; p=0.0001) were independent determinants of exercise sPAP. CONCLUSION: EIPH is frequent in SSc patients and is mainly related to both increased exercise LV filling pressure and exercise PVR.

Disciplines :

Cardiovascular & respiratory systems

Author, co-author :

Voilliot, Damien

Magne, Julien ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation

DULGHERU, Raluca Elena

Kou, Seisyou

Henri, Christine

Laaraibi, Saloua

SPRYNGER, Muriel ; Centre Hospitalier Universitaire de Liège - CHU > Cardiologie

Andre, Beatrice

Pierard, Luc ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation

Lancellotti, Patrizio ; Université de Liège - ULiège > Département des sciences cliniques > Imagerie cardiaque fonctionnelle par échographie

Language :

English

Title :

Determinants of exercise-induced pulmonary arterial hypertension in systemic sclerosis.

Publication date :

2014

Journal title :

International Journal of Cardiology

ISSN :

0167-5273

eISSN :

1874-1754

Publisher :

Elsevier, Netherlands

Peer reviewed :

Peer Reviewed verified by ORBi

Commentary :

Available on ORBi :

since 03 July 2014

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