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Overlap of coronary disease and pulmonary arterial hypertension in systemic sclerosis

A Komócsi1, T Pintér, R Faludi

  • 1University of Pécs, Heart Institute, H-7624 Pécs, Ifjúság u. 13, Hungary. andras.komocsi@aok.pte.hu

Annals of the Rheumatic Diseases
|January 23, 2009
PubMed

Insights

Systemic sclerosis (SSc) patients often have overlapping cardiac conditions like pulmonary arterial hypertension (PAH) and coronary artery disease (CAD). Invasive testing is crucial for accurate diagnosis and treatment of these complex cardiac manifestations in SSc.

Area of Science:

  • Cardiology
  • Rheumatology
  • Pulmonology

Background:

  • Pulmonary arterial hypertension (PAH) is a frequent complication of systemic sclerosis (SSc).
  • Coronary artery disease (CAD) symptoms can overlap with PAH, necessitating cardiac catheterization for definitive diagnosis.
  • Understanding the overlap between CAD and PAH in SSc patients is critical for appropriate management.

Purpose of the Study:

  • To investigate the extent of overlap between coronary artery disease (CAD) and pulmonary arterial hypertension (PAH) in patients with systemic sclerosis (SSc).

Main Methods:

  • Non-invasive investigations identified 30 SSc patients with suspected PAH (n=20) or CAD (n=10).
  • Right heart catheterization and coronary angiography were performed on these 30 patients.
  • Coronary flow reserve (CFR) was assessed using thermodilution.

Main Results:

  • PAH was diagnosed in 12/20 suspected PAH patients and 2/10 suspected CAD patients.
  • Coronary artery stenosis was found in 9/20 suspected PAH patients and 6/10 suspected CAD patients.
  • Severely reduced CFR was observed in 7/20 suspected PAH patients and 3/10 suspected CAD patients.

Conclusions:

  • A significant overlap exists between PAH, CAD, and reduced CFR in symptomatic SSc patients.
  • Current non-invasive tests lack sufficient sensitivity and specificity to differentiate these cardiac conditions in SSc.
  • Invasive approaches like coronary angiography are necessary for accurate characterization and treatment of cardiac involvement in SSc.
Abstract

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