Hemodynamic changes after acute fluid loading in patients with systemic sclerosis without pulmonary hypertension

Area of Science:

• Cardiology
• Pulmonology
• Rheumatology

Background:

• Systemic sclerosis (SSc) is associated with biventricular dysfunction.
• Pulmonary hypertension (PH) discrimination relies on fluid challenges.
• Subclinical cardiac dysfunction is common in SSc.

Purpose of the Study:

• To assess hemodynamic responses to fluid challenges in SSc patients without PH.
• To investigate pulmonary circulation changes after acute volume loading in SSc.
• To identify early signs of cardiac dysfunction in SSc.

Main Methods:

• Right heart catheterization in 25 SSc patients and 25 controls.
• Basal hemodynamic measurements followed by saline fluid challenge (7 mL/kg).
• Comparison of pulmonary artery pressures, wedge pressure, and cardiac index before and after fluid loading.

Main Results:

• No baseline hemodynamic differences between SSc patients and controls.
• SSc patients exhibited significantly greater increases in right atrial pressure, mean pulmonary artery pressure, and pulmonary artery wedge pressure post-fluid challenge.
• SSc patients showed a smaller increase in cardiac index compared to controls.
• Pulmonary vascular resistance remained similar between groups.
• Four SSc patients and one control exceeded a pulmonary artery wedge pressure of 18 mmHg.

Conclusions:

• SSc patients without overt PH demonstrate heightened pulmonary vascular pressure response and diminished cardiac output augmentation after fluid loading.
• These findings suggest underlying subclinical left ventricular diastolic dysfunction in SSc patients.
• Fluid challenges can reveal latent cardiac abnormalities in SSc, aiding in early diagnosis and management.