Abstract 12645: Hemodynamic Complications in Systemic Sclerosis Patients with Various Stages of Pulmonary Arterial Hypertension
Background: Prognosis of pulmonary arterial hypertension (PH) in systemic sclerosis (SSc) patients is poor. PH is a pathophysiological state defined by an increase in mean pulmonary arterial pressure (mPAP) ≧25 mmHg as assessed by right heart catheterization (RHC) and borderline-PH is defined by mPAP ≧ 21 mmHg. A rise in mPAP is a late marker of the pulmonary arteries remodeling processes, and the pre-clinical phase of SSc (mPAP < 21 mmHg) is largely unknown.
Objectives: To examine the hemodynamic characteristics in SSc with various stages from normal pulmonary pressure to PH stages.
Methods: 109 consecutive patients with SSc (99 women and 10 men, 85 limited cutaneous SSc and 24 diffuse cutaneous SSc; mean age 62 ± 11 yr) were assessed with first time RHC in a single center from May 2005 to May 2012. They were classified into four groups by mPAP (Table): (1) normal pressure (NP) group; mPAP <15mmHg, (2) pre-PH group; 15 ≦ mPAP < 21mmHg, (3) borderline-PH group; 21 ≦ mPAP < 25 mmHg, (4) PH group; mPAP ≧ 25mmHg.
Results: The baseline age was no significant difference. The difference in the value of brain natriuretic peptide (BNP), peak VO2, and % vital capacity / % diffusing capacity for carbon monoxide (%VC/%DLCO) changed in parallel with PH stage. In only PH group, baseline heart rate (HR) is significantly increased. Even in NP group, pulmonary vascular resistance (PVR) was already increased, that implies pulmonary arteries in SSc were damaged in the very early stage. In pre-PH group, while PVR slightly increased, Cardiac Index (CI) markedly decreased below normal limit. Decrease in stroke volume index (StVI) became significant in not only PH but also borderline-PH and pre-PH groups.
Conclusions: Patients with SSc demonstrated that even in the very early stage, PVR was already increased, and in the pre-clinical mildly mPAP increased stage, CI started declining below normal limit.
- © 2012 by American Heart Association, Inc.