Prevalence of pulmonary hypertension in limited and diffuse scleroderma.
OBJECTIVE
To characterize the prevalence of undiagnosed pulmonary hypertension in patients with limited and diffuse scleroderma.


METHODS
Prospective cross-sectional study.


METHODS
University-based outpatient clinic.


METHODS
Thirty-four consecutive patients with limited (n = 29) or diffuse (n = 5) scleroderma but without the clinical diagnosis of pulmonary hypertension.


RESULTS
All patients had 12-lead ECGs and two-dimensional and Doppler echocardiograms. The pulmonary artery systolic pressure (PAs) was calculated as the sum of the Doppler transtricuspid pressure gradient and the right atrial pressure as estimated by the caval respiratory index. Thirty-three patients (97%) had adequate spectral signals of tricuspid regurgitation. The velocity of tricuspid regurgitation ranged from 1.6 to 4.5 m/s. The calculated PAs ranged from 15 to 95 (mean +/- SD = 30 +/- 14 mm Hg). Twelve patients (35% of the total cohort) had pulmonary hypertension defined as PAs of 30 mm Hg or greater.


CONCLUSIONS
Undiagnosed elevation of PAs is common in patients with scleroderma. Noninvasive assessment of PAs can be performed accurately in most patients independent of clinical signs of pulmonary hypertension. If successful treatment strategies are identified, it may be possible to identify patients early in the development of pulmonary hypertension and intervene before significant end-organ damage occurs.
Battle
R W
RW
Division of Cardiology, University of Vermont College of Medicine, Burlington, USA.
Davitt
M A
MA
Cooper
S M
SM
Buckley
L M
LM
Leib
E S
ES
Beglin
P A
PA
Tischler
M D
MD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000503:physiopathology; D011653:Pulmonary Diffusing Capacity; D012123:Pulmonary Ventilation; D012595:Scleroderma, Systemic / Q000150:complications*; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging