Faculty Collaboration Database

Baseline characteristics and follow-up in patients with normal haemodynamics versus borderline mean pulmonary arterial pressure in systemic sclerosis: results from the PHAROS registry. Ann Rheum Dis 2012 Aug;71(8):1335-42

Date

02/07/2012

Pubmed ID

22307943

Pubmed Central ID

PMC3398226

DOI

10.1136/annrheumdis-2011-200546

Scopus ID

2-s2.0-84863812040 (requires institutional sign-in at Scopus site)   82 Citations

Abstract

BACKGROUND: Patients with normal (mean pulmonary arterial pressure (mPAP) ≤20 mm Hg) and borderline mean pulmonary pressures (21-24 mm Hg) are "at risk" of developing pulmonary hypertension (PH). The objectives of this analysis were to examine the baseline characteristics in systemic sclerosis (SSc) with normal and borderline mPAP and to explore long-term outcomes in SSc patients with borderline mPAP versus normal haemodynamics.

METHODS: PHAROS is a multicentre prospective longitudinal cohort of patients with SSc "at risk" or recently diagnosed with resting PH on right heart catheterisation (RHC). Baseline clinical characteristics, pulmonary function tests, high-resolution CT, 2-dimensional echocardiogram and RHC results were analysed in normal and borderline mPAP groups.

RESULTS: 206 patients underwent RHC (results showed 35 normal, 28 borderline mPAP, 143 resting PH). There were no differences in the baseline demographics. Patients in the borderline mPAP group were more likely to have restrictive lung disease (67% vs 30%), fibrosis on high-resolution CT and a higher estimated right ventricular systolic pressure on echocardiogram (46.3 vs 36.2 mm Hg; p<0.05) than patients with normal haemodynamics. RHC revealed higher pulmonary vascular resistance and more elevated mPAP on exercise (≥30; 88% vs 56%) in the borderline mPAP group (p<0.05 for both). Patients were followed for a mean of 25.7 months and 24 patients had a repeat RHC during this period. During follow-up, 55% of the borderline mPAP group and 32% of the normal group developed resting PH (p=NS).

CONCLUSIONS: Patients with borderline mPAP have a greater prevalence of abnormal lung physiology, pulmonary fibrosis and the presence of exercise mPAP ≥30 mm Hg.

Author List

Bae S, Saggar R, Bolster MB, Chung L, Csuka ME, Derk C, Domsic R, Fischer A, Frech T, Goldberg A, Hinchcliff M, Hsu V, Hummers L, Schiopu E, Mayes MD, McLaughlin V, Molitor J, Naz N, Furst DE, Maranian P, Steen V, Khanna D

Author

Mary Ellen Csuka MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Blood Pressure
Cardiac Catheterization
Female
Follow-Up Studies
Hemodynamics
Humans
Hypertension, Pulmonary
Male
Middle Aged
Prospective Studies
Pulmonary Artery
Pulmonary Fibrosis
Respiratory Function Tests
Scleroderma, Systemic