[en] OBJECTIVES: Cardiovascular involvement is recognized as a poor prognostic factor in systemic sclerosis (SSc). The aim of this study was to evaluate the usefulness of nailfold video-capillaroscopy (NVC), brain natriuretic peptide (BNP) blood level and exercise echocardiography to predict the occurrence of cardiovascular events in SSc. METHODS: We prospectively enrolled 65 patients with SSc (age 54+/-14 years, 30% female) followed in CHU Sart-Tilman, Liege, Belgium. All patients underwent graded semi-supine exercise echocardiography. Both baseline resting pulmonary hypertension (PH) and PH during follow-up (FUPH) were defined as systolic pulmonary arterial pressure (sPAP)>35 mmHg, and exercise-induced PH (EIPH) as sPAP>50 mmHg during exercise. RESULTS: EIPH was present in 21 patients. During FU (27+/-18 months), 13 patients developed FUPH and 9 presented cardiovascular complications. Patients with cardiovascular events were significantly older (63+/-14 vs 52+/-13 years; P=0.03), presented more frequently NVC grade>2 (89 vs 43%; P=0.009), had higher resting and exercise sPAP (30+/-6 vs 24+/-6; P=0.007 and 57+/-13 vs 44+/-13 vs mmHg; P=0.01, respectively), and higher BNP blood level (112+/-106 vs 26+/-19 pg/ml; P=0.0001). After adjustment for age and gender, NVC grade>2 (ss=2.4+/-1.1; P=0.03), EIPH (ss=2.30+/-1.13; P=0.04), FUPH (ss=0.24+/-0.09; P=0.01 and ss=3.52+/-1.16; P=0.002, respectively;) and BNP (ss=0.08+/-0.04; P=0.02) were independent predictors of CV events. Beyond age, an incremental value of EIPH, BNP and NVC grade>2 was predictive of cardiovascular events (P<0.001). CONCLUSION: Cardiovascular complications are not rare in SSc (18%). NVC, BNP blood level assessment and exercise echocardiography could be useful tools to identify patients at risk of SSc.
Association Royale des Sociétés Scientifiques Medicales Belges/Koninklijke Vereniging van de Belgische Medische Wetenschappelijke Genootschappen, Bruxelles, Belgium
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