title: Cardiovascular outcome in systemic sclerosis.
abstract: OBJECTIVE
  Cardiovascular involvement is recognized as a poor prognostic factor in systemic sclerosis (SSc). The aim of this study was to evaluate the usefulness of nailfold video-capillaroscopy (NVC), brain natriuretic peptide (BNP) blood level and exercise echocardiography to predict the occurrence of cardiovascular events in SSc.
  
  
  METHODS
  We prospectively enrolled 65 patients with SSc (age 54±14 years, 30% female) followed in CHU Sart-Tilman, Liège, Belgium. All patients underwent graded semi-supine exercise echocardiography. Both baseline resting pulmonary hypertension (PH) and PH during follow-up (FUPH) were defined as systolic pulmonary arterial pressure (sPAP)>35 mmHg, and exercise-induced PH (EIPH) as sPAP>50 mmHg during exercise.
  
  
  RESULTS
  EIPH was present in 21 patients. During FU (27±18 months), 13 patients developed FUPH and 9 presented cardiovascular complications. Patients with cardiovascular events were significantly older (63±14 vs 52±13 years; P=0.03), presented more frequently NVC grade>2 (89 vs 43%; P=0.009), had higher resting and exercise sPAP (30±6 vs 24±6; P=0.007 and 57±13 vs 44±13 vs mmHg; P=0.01, respectively), and higher BNP blood level (112±106 vs 26±19 pg/ml; P=0.0001). After adjustment for age and gender, NVC grade>2 (ß=2.4±1.1; P=0.03), EIPH (ß=2.30±1.13; P=0.04), FUPH (ß=0.24±0.09; P=0.01 and ß=3.52±1.16; P=0.002, respectively;) and BNP (ß=0.08±0.04; P=0.02) were independent predictors of CV events. Beyond age, an incremental value of EIPH, BNP and NVC grade>2 was predictive of cardiovascular events (P<0.001).
  
  
  CONCLUSIONS
  Cardiovascular complications are not rare in SSc (18%). NVC, BNP blood level assessment and exercise echocardiography could be useful tools to identify patients at risk of SSc.
authors.forename: Damien
authors.initials: D
authors.lastname: Voilliot
authors.forename: Julien
authors.initials: J
authors.lastname: Magne
authors.forename: Raluca
authors.initials: R
authors.lastname: Dulgheru
authors.forename: Seisyou
authors.initials: S
authors.lastname: Kou
authors.forename: Christine
authors.initials: C
authors.lastname: Henri
authors.forename: Luis
authors.initials: L
authors.lastname: Caballero
authors.forename: Carla
authors.initials: C
authors.lastname: De Sousa
authors.forename: Muriel
authors.initials: M
authors.lastname: Sprynger
authors.forename: Béatrice
authors.initials: B
authors.lastname: Andre
authors.forename: Luc A
authors.initials: LA
authors.lastname: Pierard
authors.forename: Patrizio
authors.initials: P
authors.lastname: Lancellotti
mesh_terms: D000328:Adult; D000368:Aged; D062186:Arterial Pressure; D001530:Belgium; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D025401:Echocardiography, Stress; D005080:Exercise Test; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008833:Microcirculation; D020678:Microscopic Angioscopy; D008875:Middle Aged; D009262:Nails / Q000098:blood supply*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000150:complications* / Q000175:diagnosis
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
keywords: Systemic sclerosis; brain natriuretic peptide; cardio-vascular diseases; echocardiography; exercise; nailfold videocapillaroscopy; pulmonary hypertension