Document Detail

Exercise-induced pulmonary hypertension associated with systemic sclerosis: four distinct entities.
MedLine Citation:
PMID:  20722025     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Exercise-induced pulmonary hypertension (PH) may represent an early but clinically relevant phase in the spectrum of pulmonary vascular disease. There are limited data on the prevalence of exercise-induced PH determined by right heart catheterization in scleroderma spectrum disorders. We undertook this study to describe the hemodynamic response to exercise in a homogeneous population of patients with scleroderma spectrum disorders at risk of developing pulmonary vascular disease.
METHODS: Patients with normal resting hemodynamics underwent supine lower extremity exercise testing. A classification and regression tree (CART) analysis was used to assess combinations of variables collected during resting right heart catheterization that best predicted abnormal exercise physiology, applicable to each individual subject.
RESULTS: Fifty-seven patients who had normal resting hemodynamics underwent subsequent exercise right heart catheterization. Four distinct hemodynamic groups were identified during exercise: a normal group, an exercise-induced pulmonary venous hypertension (ePVH) group, an exercise out of proportion PH (eoPH) group, and an exercise-induced PH (ePH) group. The eoPH and ePVH groups had higher pulmonary capillary wedge pressure (PCWP) than the ePH group (P < 0.05). The normal and ePH groups had exercise PCWP ≤18 mm Hg, which was lower than that in the ePVH and eoPH groups (P < 0.05). During submaximal exercise, the transpulmonary gradient and pulmonary vascular resistance (PVR) were elevated in the ePH and eoPH groups as compared with the normal and ePVH groups (P < 0.05). CART analysis suggested that resting mean pulmonary artery pressure (mPAP) ≥14 mm Hg and PVR ≥160 dynes/seconds/cm(-5) were associated with eoPH and ePH (positive predictive value 89% for mPAP 14-20 mm Hg and 100% for mPAP >20 mm Hg).
CONCLUSION: We characterized the exercise hemodynamic response in at-risk patients with scleroderma spectrum disorders who did not have resting PH. Four distinct hemodynamic groups were identified during exercise. These groups may have potentially different prognoses and treatment options.
Rajeev Saggar; Dinesh Khanna; Daniel E Furst; Shelley Shapiro; Paul Maranian; John A Belperio; Neeraj Chauhan; Philip Clements; Alan Gorn; S Sam Weigt; David Ross; Joseph P Lynch; Rajan Saggar
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Arthritis and rheumatism     Volume:  62     ISSN:  1529-0131     ISO Abbreviation:  Arthritis Rheum.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-12-01     Completed Date:  2011-03-09     Revised Date:  2014-09-08    
Medline Journal Info:
Nlm Unique ID:  0370605     Medline TA:  Arthritis Rheum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3741-50     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 by the American College of Rheumatology.
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MeSH Terms
Cardiac Catheterization
Cohort Studies
Decision Trees
Hemodynamics / physiology
Hypertension, Pulmonary / classification*,  epidemiology,  physiopathology*
Middle Aged
Retrospective Studies
Risk Factors
Scleroderma, Systemic / complications*,  physiopathology*
Vital Capacity / physiology
Grant Support
K23 AR053858/AR/NIAMS NIH HHS; K23 AR053858-03/AR/NIAMS NIH HHS; K23-AR-053858-03/AR/NIAMS NIH HHS

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