title: High prevalence of occult left heart disease in scleroderma-pulmonary hypertension.
abstract: Our study aimed to determine the prevalence of occult left-heart disease in patients with scleroderma and pulmonary hypertension. In patients with pulmonary hypertension (mean pulmonary artery pressure (mean PAP)≥25 mmHg), differentiation between pre- and post-capillary pulmonary hypertension has been made according to pulmonary artery wedge pressure (PAWP) less than or more than 15 mmHg, respectively. We performed a retrospective chart review of 107 scleroderma patients. All patients with suspected pulmonary hypertension had routine right or left heart catheterisation with left ventricular end-diastolic pressure (LVEDP) measurement pre-/post-fluid challenge. We extracted demographic, haemodynamic and echocardiographic data. Patients were classified into one of four groups: haemodynamically normal (mean PAP<25 mmHg); pulmonary venous hypertension (PVH) (mean PAP≥25 mmHg, PAWP>15 mmHg); occult PVH (mean PAP≥25 mmHg, PAWP≤15 mmHg, LVEDP>15 mmHg before or after fluid challenge); and pulmonary arterial hypertension (PAH) (mean PAP≥25 mmHg, PAWP≤15 mmHg and LVEDP≤15 mmHg before or after fluid challenge). 53 out of 107 patients had pulmonary hypertension. Based on the PAWP-based definition, 29 out of 53 had PAH and 24 out of 53 had PVH. After considering the resting and post-fluid-challenge LVEDP, 11 PAH patients were reclassified as occult PVH. The occult PVH group was haemodynamically, echocardiographically and demographically closer to the PVH group than the PAH group. PVH had high prevalence in our scleroderma-pulmonary hypertension population. Distinguishing PAH from PVH with only PAWP may result in some PVH patients being misclassified as having PAH.
authors.affiliation: Divisions of Cardiology, Respirology and Rheumatology, and Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Fox
authors.forename: Avi
authors.initials: A
authors.lastname: Shimony
authors.forename: David
authors.initials: D
authors.lastname: Langleben
authors.forename: Andrew
authors.initials: A
authors.lastname: Hirsch
authors.forename: Lawrence
authors.initials: L
authors.lastname: Rudski
authors.forename: Robert
authors.initials: R
authors.lastname: Schlesinger
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Eisenberg
authors.forename: Dominique
authors.initials: D
authors.lastname: Joyal
authors.forename: Marie
authors.initials: M
authors.lastname: Hudson
authors.forename: Kim
authors.initials: K
authors.lastname: Boutet
authors.forename: Alexandrina
authors.initials: A
authors.lastname: Serban
authors.forename: Ariel
authors.initials: A
authors.lastname: Masetto
authors.forename: Murray
authors.initials: M
authors.lastname: Baron
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization; D020000:Decision Support Systems, Clinical; D004452:Echocardiography / Q000379:methods; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006331:Heart Diseases / Q000150:complications* / Q000175:diagnosis*; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011669:Pulmonary Wedge Pressure; D012189:Retrospective Studies; D012595:Scleroderma, Systemic / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*