Patients with systemic sclerosis and borderline pulmonary arterial pressures display reduced right ventricular contractile reserve

B Egenlauf; A Marra; C Nagel; S Harutyunova; HM Lorenz; N Blank; C Fiehn; E Hadaschik; N Benjamin; C Fischer; E Grünig

doi:10.1055/s-0037-1619134

Pneumologie, Table of Contents

Pneumologie 2018; 72(S 01): S7
DOI: 10.1055/s-0037-1619134

Sektion 6 – Kardiorespiratorische Interaktion

Freie Vorträge – Titel: Kardiale Funktion bei pneumologischen Patienten, neue Messmethoden und Frühdiagnostik

Georg Thieme Verlag KG Stuttgart · New York

Patients with systemic sclerosis and borderline pulmonary arterial pressures display reduced right ventricular contractile reserve

Authors

B Egenlauf

¹Centre for Pulmonary Hypertension at the Thoraxclinic, University Hospital Heidelberg
A Marra

¹Centre for Pulmonary Hypertension at the Thoraxclinic, University Hospital Heidelberg
C Nagel

¹Centre for Pulmonary Hypertension at the Thoraxclinic, University Hospital Heidelberg
S Harutyunova

¹Centre for Pulmonary Hypertension at the Thoraxclinic, University Hospital Heidelberg
HM Lorenz

²Department of Rheumatology, University Hospital Heidelberg
N Blank

²Department of Rheumatology, University Hospital Heidelberg
C Fiehn

³Praxis für Rheumatologie und Klinische Immunologie, Baden-Baden
E Hadaschik

⁴Department of Dermatology, University of Heidelberg
N Benjamin

¹Centre for Pulmonary Hypertension at the Thoraxclinic, University Hospital Heidelberg
C Fischer

⁵Institute of Human Genetics, University of Heidelberg
E Grünig

¹Centre for Pulmonary Hypertension at the Thoraxclinic, University Hospital Heidelberg

Abstract

Full Text

Background:

Borderline pulmonary arterial pressures (BoPAP) in patients with systemic sclerosis (SSc) are a frequent finding and could represent an intermediate stage between normal pulmonary pressures and manifest pulmonary hypertension (PH).

Objectives:

To characterize the difference in right ventricular response to exercise between SSc patients with normal hemodynamics and BoPAP-patients.

Methods:

Patients with confirmed SSc (n = 112) underwent right heart catheterization (RHC) at rest and during exercise and were divided into three groups according to their resting mean pulmonary artery pressure (mPAP) values: normal (mPAp ≤20 mmHg), BoPAP (mPAP 21 – 24 mmHg) and manifest PH (mPAp ≥25 mmHg).

Results:

SSc patients with BoPAP showed significantly lower right ventricular contractile reserve than SSc patients with normal hemodynamics as shown by reduced cardiac output (CO) and cardiac index (CI) increase during exercise measured by RHC (Δ CO: 5.76 ± 2.56 l/min vs. 3.51 ± 2.50, p < 0.003; Δ CI: 3.31 ± 1.52 vs. 2.11 ± 1.18 l/min/m², p < 0.006).

Conclusion:

SSc patients with BoPAP already displayed a reduced right ventricular contractile reserve together with elevated pulmonary vascular resistance and transpulmonary gradient and reduced exercise capacity compared with SSc patients and normal resting hemodynamics. This lends support to BoPAP being an early stage of pulmonary vascular disease.