| Borderline pulmonary arterial pressure is associated with decreased exercise capacity in scleroderma. | |
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MedLine Citation:
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PMID: 19679693 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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RATIONALE: Pulmonary arterial hypertension is associated with impaired exercise capacity and decreased survival in patients with scleroderma. Randomized controlled studies showed significant benefit of targeted therapies in patients with a resting mean pulmonary arterial pressure (MPAP) greater than 25 mm Hg. The clinical relevance of pulmonary arterial pressure values in the upper normal range is unknown. OBJECTIVES: To examine the clinical relevance of pulmonary arterial pressure in scleroderma patients. METHODS: After a noninvasive screening program, 29 patients with systemic sclerosis without significant lung fibrosis and without known pulmonary arterial hypertension underwent right heart catheterization and simultaneous cardiopulmonary exercise test. A six-minute walk distance (6MWD) was determined within 48 hours. MEASUREMENTS AND MAIN RESULTS: A resting MPAP above the median (17 mm Hg) was associated with decreased 6MWD (396 +/- 71 vs. 488 +/- 76 m; P < 0.005) and peak Vo(2) (76 +/- 11% vs. 90 +/- 24%; P = 0.05). Resting pulmonary vascular resistance was inversely correlated with 6MWD (r = 0.45; P < 0.05). At 25 and 50W, MPAP above the median (23 and 28 mm Hg) was associated with decreased 6MWD (P < 0.005; P < 0.0005). At peak exercise, MPAP showed no association with 6MWD or peak Vo(2); however, cardiac index was positively (r = 0.45; P < 0.05) and pulmonary vascular resistance was negatively correlated with 6MWD (r = -0.38; P < 0.05). CONCLUSIONS: MPAP and resistance in the upper normal range at rest and moderate exercise are associated with decreased exercise capacity and may indicate early pulmonary vasculopathy in patients with systemic sclerosis. Investigations on the prognostic and therapeutic implications of such borderline findings are warranted. Clinical trial registered with http://www.clinicaltrials.gov (NCT00609349). |
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Authors:
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Gabor Kovacs; Robert Maier; Elisabeth Aberer; Marianne Brodmann; Stefan Scheidl; Natascha Tröster; Christian Hesse; Wolfgang Salmhofer; Winfried Graninger; Ekkehard Gruenig; Lewis J Rubin; Horst Olschewski |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2009-08-13 |
Journal Detail:
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Title: American journal of respiratory and critical care medicine Volume: 180 ISSN: 1535-4970 ISO Abbreviation: Am. J. Respir. Crit. Care Med. Publication Date: 2009 Nov |
Date Detail:
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Created Date: 2009-10-21 Completed Date: 2009-12-01 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9421642 Medline TA: Am J Respir Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 881-6 Citation Subset: AIM; IM |
Affiliation:
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Department of Pulmonology, Medical University Graz, Graz, Austria. |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00609349 |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Blood Pressure* Exercise Exercise Test / methods, statistics & numerical data Exercise Tolerance* Heart Catheterization Humans Middle Aged Rest Scleroderma, Systemic / physiopathology* Vascular Resistance Walking |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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