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- Title
Influence of Pulmonary Vascular Reserve on Exercise-Induced Pulmonary Hypertension in Patients with Systemic Sclerosis.
- Authors
Suzuki, Kengo; Izumo, Masaki; Kamijima, Ryo; Mizukoshi, Kei; Takai, Manabu; Kida, Keisuke; Yoneyama, Kihei; Nobuoka, Sachihiko; Yamada, Hidehiro; Akashi, Yoshihiro J.
- Abstract
Background Exercise-induced pulmonary hypertension ( PH) is considered as an early preclinical functional phase of resting PH in systemic sclerosis ( SSc). In this study, we investigated the prevalence of exercise-induced PH in patients with SSc and evaluated the influence of pulmonary vascular reserve on exercise-induced PH. Methods This prospective study included 568 SSc patients. The patients with interstitial lung disease and those with left ventricular dysfunction were excluded (n = 50); finally, 518 patients underwent simple exercise echocardiography using a Master's two-step. Systolic pulmonary artery pressure ( SPAP), the ratio of early diastolic transmitral flow velocity to early diastolic mitral annular velocity (E/e') and pulmonary vascular resistance ( PVR) were measured before and after exercise. Δ PVR (the difference between rest and post) was used for the assessment of pulmonary vascular reserve. All patients were stratified into the no exercise-induced PH ( SPAP <50 mmHg) or exercise-induced PH ( SPAP ≥50 mmHg, n = 133) group. Results Of the study patients, 27% patients were identified as having exercise-induced PH. Δ PVR was higher in the exercise-induced PH than no exercise-induced PH group (0.2 ± 0.3 vs. 0.4 ± 0.4 WU, P < 0.0001). A weak correlation was found between postexercise SPAP and postexercise E/e' (r = 0.31, P < 0.0001), whereas a strong correlation was found between postexercise SPAP and postexercise PVR (r = 0.62, P < 0.0001). The analyzed data demonstrated that Δ PVR was independently associated with exercise-induced PH (odds ratio, 3.435; 95% CI, 1.013-11.650, P = 0.033). Conclusions The present study demonstrated that exercise-induced PH was common in patients with SSc. Exercise-induced PH might be closely associated with the factors affecting reduced pulmonary vascular reserve in patients with SSc.
- Subjects
ECHOCARDIOGRAPHY; CHI-squared test; CONFIDENCE intervals; STATISTICAL correlation; EXERCISE; LONGITUDINAL method; PULMONARY hypertension; RESEARCH evaluation; STATISTICS; SYSTEMIC scleroderma; DATA analysis; MULTIPLE regression analysis; INTER-observer reliability; DATA analysis software; DESCRIPTIVE statistics; ODDS ratio; DISEASE complications
- Publication
Echocardiography, 2015, Vol 32, Issue 3, p428
- ISSN
0742-2822
- Publication type
Article
- DOI
10.1111/echo.12690