High prevalence of occult left ventricular diastolic dysfunction detected by exercise stress test in systemic...

Area of Science:

• Cardiology
• Rheumatology
• Pulmonary Hypertension

Background:

• Systemic sclerosis (SSc) is associated with a poor prognosis, often linked to left ventricular diastolic dysfunction (LVDD).
• Occult LVDD, present even with normal resting hemodynamics, remains under-investigated in SSc patients.

Purpose of the Study:

• To determine the prevalence of occult LVDD in SSc patients.
• To identify determinants of occult LVDD using exercise stress testing.
• To evaluate the utility of pulmonary artery wedge pressure (PAWP) during exercise and leg raise for detecting occult LVDD.

Main Methods:

• Retrospective analysis of 45 SSc patients with normal resting pulmonary artery pressure and PAWP.
• Symptom-limited exercise testing with right heart catheterization using a supine cycle ergometer.
• Evaluation of hemodynamic parameters at rest, during leg raise, and exercise; occult LVDD defined as PAWP ≥ 25 mmHg during exercise.

Main Results:

• Occult LVDD was identified in 13 patients (29%) during exercise.
• Patients with occult LVDD exhibited higher resting PAWP, lower pulmonary vascular resistance, larger left atrium, and significantly higher PAWP after leg raise (15 ± 4 mmHg vs. 10 ± 4 mmHg).
• PAWP after leg raise demonstrated strong diagnostic capability for occult LVDD (Area Under ROC Curve = 0.83).

Conclusions:

• Approximately one-third of SSc patients with normal resting hemodynamics have occult LVDD.
• Elevated PAWP following a leg raise maneuver is a potential indicator for detecting occult LVDD in SSc.
• Early detection of occult LVDD may improve management and prognosis in SSc patients.