Document Detail

Clinical and echocardiographic correlations of exercise-induced pulmonary hypertension in systemic sclerosis: a multicenter study.
MedLine Citation:
PMID:  23351823     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Patients with systemic sclerosis (SSc) are at risk for developing pulmonary hypertension, which is associated with a poor prognosis. Exercise Doppler echocardiography enables the identification of exercise-induced increase in pulmonary artery systolic pressure (PASP) and may provide a thorough noninvasive hemodynamic evaluation.
AIM: The aim of this study was to evaluate the clinical and echocardiographic determinants of exercise-induced increase in PASP in a large population of patients with SSc.
METHODS: We selected 164 patients with SSc (age 58 ± 13 years, 91% female) with normal resting PASP (<40 mm Hg) who underwent a comprehensive 2-dimensional and Doppler echocardiography and graded bicycle semisupine exercise Doppler echocardiography. Pulmonary artery systolic pressure, cardiac output, and pulmonary vascular resistance (PVR) were estimated noninvasively. Cutoff values of PASP ≥50 mm Hg and PVR ≥3.0 Wood Units at peak exercise were considered a significant exercise-induced increase in PASP and PVR, respectively.
RESULTS: Sixty-nine (42%) patients showed a significant exercise-induced increase in PASP. Among them, peak PVR ≥3 Wood Units was present only in 11% of patients, about 5% of the total population. Univariate analysis showed that age, presence of interstitial lung disease, and both right and left diastolic dysfunction are predictors of peak PASP ≥50 mm Hg, but none of these parameters predict elevated peak PVR.
CONCLUSIONS: Exercise-induced increase in PASP occurs in almost one-half of patients with SSc with normal resting PASP. Peak exercise PASP is affected by age, interstitial lung disease, and right and left ventricular diastolic dysfunction and, only in 5% of the patients, is associated with an increase in PVR during exercise, suggesting heterogeneity of the mechanisms underlying exercise-induced pulmonary hypertension in SSc.
Luna Gargani; Alberto Pignone; Gergely Agoston; Antonella Moreo; Eugenia Capati; Luigi P Badano; Marica Doveri; Laura Bazzichi; Marco Fabio Costantino; Andrea Pavellini; Francesco Pieri; Francesco Musca; Denisa Muraru; Oscar Epis; Eleonora Bruschi; Benedetta De Chiara; Federico Perfetto; Fabio Mori; Oberdan Parodi; Rosa Sicari; Stefano Bombardieri; Albert Varga; Marco Matucci Cerinic; Eduardo Bossone; Eugenio Picano
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study     Date:  2012-11-28
Journal Detail:
Title:  American heart journal     Volume:  165     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-28     Completed Date:  2013-03-21     Revised Date:  2013-10-21    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  200-7     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 Mosby, Inc. All rights reserved.
Institute of Clinical Physiology, National Council of Research, Pisa, Italy.
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MeSH Terms
Echocardiography, Doppler / methods*
Exercise / physiology*
Exercise Test / adverse effects*
Follow-Up Studies
Hypertension, Pulmonary / etiology*,  physiopathology,  ultrasonography
Middle Aged
Pulmonary Wedge Pressure*
Retrospective Studies
Scleroderma, Systemic / complications*,  physiopathology
Vascular Resistance
Comment In:
Am Heart J. 2013 Sep;166(3):e13   [PMID:  24016514 ]
Am Heart J. 2013 Sep;166(3):e15-6   [PMID:  24016515 ]

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