Document Detail


Exercise-induced pulmonary arterial hypertension in patients with systemic sclerosis.
MedLine Citation:
PMID:  18403670     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Pulmonary arterial hypertension (PAH) is the most common cause of scleroderma-related deaths. New medications for PAH patients make it necessary to identify patients with high risk factors for PAH. This study looks at the use of an exercise echocardiogram in identifying patients who may have PAH and may be candidates for early therapeutic intervention. METHODS: This study included 54 scleroderma patients with symptoms suggesting they were at risk for pulmonary hypertension, including dyspnea on exertion, diffusing capacity of the lung for carbon monoxide (Dlco)<60% of predicted, FVC<70% of predicted, percentage of predicted FVC/percentage of predicted Dlco (FVC%/Dlco%) ratio>1.6, or resting right ventricular systolic pressure (RVSP)>35 mm Hg. The exercise echocardiogram protocol involved the standard Bruce stress echocardiogram protocol with remeasurement of the RVSP within 1 min of stopping exercise. A positive exercise test result was defined as an increase of at least 20 mm Hg in the RVSP with exercise. Right-heart catheterization with exercise was performed in those with a positive exercise test result. RESULTS: Resting mean RVSP was 34.5 mm Hg, which increased to 51.4 mm Hg with exercise; 44% had at a positive exercise test result, which correlated with a low Dlco, high FVC%/Dlco% ratio (p<0.001), a positive anti-centromere antibody, and RVSP>35 mm Hg (p<0.05). PAH was confirmed by right-heart catheterization in 81% of patients: 19% at rest and 62% of patients with exercise. CONCLUSIONS: Exercise-induced pulmonary hypertension is a common finding in patients at high risk for PAH. This may be a sensitive way to identify patients with early PAH. Long-term follow-up and early treatment should be studied in these patients.
Authors:
Virginia Steen; Maria Chou; Victoria Shanmugam; Martin Mathias; Tunay Kuru; Richard Morrissey
Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-04-10
Journal Detail:
Title:  Chest     Volume:  134     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-07-16     Completed Date:  2008-08-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  146-51     Citation Subset:  AIM; IM    
Affiliation:
Georgetown University School of Medicine, Georgetown University, Department of Medicine, LL Gorman, Washington, DC 20007, USA. steenv@georgetown.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Blood Pressure / physiology
Disease Progression
Echocardiography, Doppler
Exercise / physiology*
Exercise Test
Female
Heart Rate / physiology
Humans
Hypertension, Pulmonary / etiology*,  physiopathology,  ultrasonography*
Male
Middle Aged
Predictive Value of Tests
Pulmonary Artery / physiopathology
Respiratory Function Tests
Scleroderma, Systemic / complications*,  physiopathology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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