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Exercise‐Induced Pulmonary Hypertension in Scleroderma Patients: A Common Finding but with Elusive Pathophysiology
Author(s) -
Baptista Rui,
Serra Sara,
Martins Rui,
Salvador Maria João,
Castro Graça,
Gomes Manuel,
Santos Lèlita,
Monteiro Pedro,
Silva Jose A. Pereira,
Pêgo Mariano
Publication year - 2013
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12063
Subject(s) - medicine , cardiology , pulmonary hypertension , pulmonary artery , pulmonary wedge pressure , ventricle , pathophysiology , vascular resistance , blood pressure
Background: The etiology of exercise‐induced pulmonary hypertension (ex PH ) in systemic sclerosis ( SS c) remains a complex task, as both left ventricle ( LV ) diastolic dysfunction and pulmonary vascular disease can contribute to its development. We determined the incidence of ex PH in SS c and examined the association between pulmonary artery systolic pressure ( PASP ) and tissue D oppler‐derived indexes of pulmonary capillary wedge pressure ( PCWP ). Methods: Thirty‐eight patients with SS c were studied, using a cycloergometer protocol; 10 were excluded due to resting PH or absence of tricuspid regurgitation ( TR ); TR and mitral E‐wave velocities, LV outflow tract time‐velocity integral and LV septal E′‐wave were measured before and in peak exercise to calculate cardiac output ( CO ), PCWP and pulmonary vascular resistance ( PVR ). Results: Mean age of diagnosis was 57.9 ± 8.9 years. At a mean workload of 64 ± 29 Watts, 48% of patients increased PASP ≥ 50 mmHg. PCWP , assessed by the E/e′ ratio, did not change significantly during exercise (10.2 ± 3.1–10.0 ± 5.1; P = NS ). Only 3 patients had elevations of the E/e′ ratio ≥ 13 during exercise; 2 of them had an exercise PASP ≥ 50 mmHg, yielding a proportion of ex PH due to elevated LV filling pressures of 2/11 (18%). Patients with ex PH had lower DL CO and had more frequently the diffuse SS c. Conclusion: The elevation of PASP during exercise in most patients of this cohort seems to be related to a reduced pulmonary vascular reserve, and not to an increase in PCWP . Further studies are warranted to determine the therapeutic, as well as prognostic implications of these findings.