Exercise pulmonary haemodynamics predict outcome in patients with systemic sclerosis

Area of Science:

• Cardiology
• Pulmonary Medicine
• Rheumatology

Background:

• Systemic sclerosis (SSc) patients often develop pulmonary hypertension (PH).
• Prognostic value of exercise hemodynamics in SSc-PH evaluation is not well understood.

Purpose of the Study:

• To investigate the prognostic significance of exercise hemodynamics during right heart catheterization (RHC) in SSc patients.
• To identify early markers of pulmonary vasculopathy in SSc.

Main Methods:

• Right heart catheterization (RHC) at rest and during maximal exercise in 72 SSc patients.
• Classification into resting PH (PHrest), exercise-induced PH (PHex), and no PH (PHnone).
• Survival analysis using Kaplan-Meier and Cox regression models.

Main Results:

• Survival without transplantation was significantly lower in PHrest (4.4 years) and PHex (5.2 years) compared to PHnone (9.5 years).
• Exercise-induced increase in mean pulmonary artery pressure (mPAP) and impaired pulmonary vascular distensibility predicted transplant-free survival.
• Resting hemodynamics did not predict survival in Cox models.

Conclusions:

• Exercise hemodynamics during RHC provide prognostic information in SSc patients.
• Elevated mPAP and reduced vascular distensibility during exercise may indicate early pulmonary vasculopathy and reduced survival.
• These findings suggest exercise RHC is valuable for risk stratification in SSc.