SESSION TITLE: PAH and the Heart
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 28, 2015 at 08:45 AM - 10:00 AM
PURPOSE: To investigate whether a significant increase in right ventricular systolic pressure (RVSP) during exercise echocardiography (ExEcho) is a risk factor for the development of pulmonary hypertension (PHTN) in patients with Systemic Sclerosis (SSc).
METHODS: We prospectively evaluated SSc patients with signs or symptoms of PHTN, including dyspnea on exertion, DLCO < 60% of predicted, FVC < 70%, ratio of FVC% to DLCO% > 1.6, or resting RVSP > 35 mmHg. All patients underwent baseline ExEcho between 2003 and 2008. The exercise protocol involved standard Bruce stress Echo protocol with remeasurement of RVSP within one minute of exercise cessation. Exercise-induced pulmonary hypertension (ExPHTN) was defined as an increase in RSVP by > 20 mmHg post-exercise. We included patients who had follow-up Echo at least one year after their baseline ExEcho. PHTN on follow-up Echo was defined as resting RVSP > 40 mmHg.
RESULTS: 55 patients had baseline ExEcho and follow up Echo, mean 5.5 ± 2.1 years. Baseline mean characteristics were age 53 ± 12 years, 96% female, DLCO 63 ± 22%, FVC 84 ± 19%, SMWD 439 ± 109 m. Six patients were on PDE-5 inhibitors for digital ulcers. On baseline ExEcho, 21 patients (38%) met criteria for ExPHTN, of whom 6 (29%) developed PHTN on follow-up. Among 34 patients without baseline ExPHTN , 4 (12%) developed PHTN (P=NS). There were no differences in age, DLCO, FVC, SMWD or therapy amongst patients with and without baseline ExPHTN, and amongst patients who did or did not develop PHTN at follow up. Among all patients who developed PHTN (18%), baseline RVSP and post-exercise RVSP were higher compared to those who did not develop PHTN, 37 ± 6 vs 32 ± 6 mmHg (P=0.02) and 53 ± 15 vs 48 ± 13 mmHg (P=0.04). Sensitivity and specificity of baseline ExEcho for development of PTHN was 60% and 67% respectively. Positive and negative predictive values were 29% and 88% respectively.
CONCLUSIONS: Among patients with SSc and long-term follow up, no clinically significant risk factors for the development of PHTN were identified. In this study, ExEcho demonstrated good performance in identifying patients who were at low risk for PHTN.
CLINICAL IMPLICATIONS: ExEcho can be a useful adjunct in identifying patients who are at low risk for developing PHTN. Future studies should confirm ExEcho findings with right heart catheterization, and investigate if ExEcho can be combined with other modalities to improve its diagnostic performance.
DISCLOSURE: Virginia Steen: Grant monies (from industry related sources): grant, University grant monies: grant Tunay Kuru: Consultant fee, speaker bureau, advisory committee, etc.: Speaker The following authors have nothing to disclose: Stephanie Wappel
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