Exercise Pulmonary Resistances Predict Long-Term Survival in Systemic Sclerosis.

Area of Science:

• Cardiology
• Pulmonology
• Rheumatology

Background:

• Pulmonary hemodynamics during exercise can indicate early pulmonary vascular disease.
• This has clinical and prognostic relevance in systemic sclerosis (SSc).
• The prognostic value of exercise pulmonary resistances in SSc patients with normal or mildly elevated mean pulmonary arterial pressure (mPAP) is assessed.

Purpose of the Study:

• To determine if pulmonary resistances at peak exercise are independent predictors of mortality in systemic sclerosis (SSc).

Main Methods:

• Retrospective analysis of 80 SSc patients with resting mPAP < 25 mm Hg and exercise right heart catheterization.
• Age-adjusted Cox regression analysis to assess the association between pulmonary resistances and all-cause mortality.

Main Results:

• Exercise pulmonary vascular resistance (PVR) and total pulmonary resistance (TPR) significantly predicted mortality (P = .006 and P = .026, respectively).
• Resting PVR and TPR did not significantly predict mortality.
• Slopes of mPAP/CO and TPG/CO were also significant predictors of mortality (P = .047 and P = .034, respectively).
• Exercise PVR demonstrated high accuracy in predicting 10-year mortality (AUC = 0.917).

Conclusions:

• Pulmonary vascular resistance (PVR) and total pulmonary resistance (TPR) during peak exercise are significant predictors of long-term mortality in SSc patients.
• The mPAP/CO and TPG/CO slopes also predict mortality in this cohort.
• Exercise-derived hemodynamic parameters offer valuable prognostic information in SSc.