ASSESSMENT OF PULMONARY HYPERTENSION IN SYSTEMIC SCLEROSIS BY EXERCISE ECHOCARDIOGRAPHY

Background: Pulmonary arterial hypertension (PAH) is an important cause of morbidity and mortality in systemic sclerosis. An early and correct diagnosis of this condition is of great importance given the recent advances in treatment of PAH.Objectives: To investigate whether exercise echocardiography could be a more sensitive non-invasive diagnostic test of pulmonary hypertension by comparison with rest echocardiography.Methods: Ten patients with systemic sclerosis (3 diffuse, 5 limited scleroderma and 2 overlap syndromes; mean age 44,4 years; 9 females) underwent color Doppler, M-mode and 2D-echocardiography. The presence of tricuspid regurgitation and tricuspid gradient (gRV/RA) was measured at rest in left lateral position and in upright position at rest and after peak exercise using a modified Bruce protocol. Results were compared with a control group of 10 pts with similar demografic charateristics and suspected coronary artery disease but with a negative exercise test for ischemia.Results: At baseline two patients were found to have increased tricuspid gradient, one of them was excluded from analysis because of the presence of mitral valve stenosis. After exercise four patients (44%) developed tricuspid gradient that was sever in half of them (gRV/RA 40,43,70 and 75 mmHg). In the control group only 2 (20%) developed a mild gradient (gRV/RA 36 and 45 mmHg).Conclusion: Exercise echocardiography can identify patients that develop tricuspid gradient during exercise, even with normal echo values at rest.Albeit these small numbers it seems to be a safe and sensitive tool that can be used in the screening of scleroderma patients for the presence of PAH.Citation: , volume , supplement , year 2004, page Session: Scleroderma and related syndromes