Noninvasive Evaluation Of Right Ventricle Systolic Pressure During Dynamic Exercise by Saline-Enhanced Doppler Echocardiography in Progressive Systemic Sclerosis

Abstract

Progressive systemic sclerosis (PSS) is characterized in its first phases by vascular damage. Lungs are involved in two thirds of patients with initial progressive destruction of the capillary bed and consequent reduction of the functional reserve, which may lead to hypertension of the pulmonary circulation. For these reasons it is of great interest to have early information about the pressure of the pulmonary circulation, both at rest and during exercise, to follow the progression and the evolution of the illness independently from subjective symptoms. The aim of the study was to evaluate by a noninvasive method, saline-enhanced Doppler echocardiography, the behavior of the right ventricular systolic pressure in patients with PSS, at rest and during exercise, without clear instrumental or clinical signs of pulmonary involvement at rest. Nine patients (7 women and 2 men) with PSS, aged 55.7 +/- 8.7 years, and 9 control subjects were evaluated. All patients had normal pulmonary pressure at rest and negative history for effort dyspnea. Subjects underwent Doppler echocardiographic examination at rest and during exercise. Right ventricular systolic pressure was evaluated by saline-enhanced Doppler technique, at rest and throughout exercise. At rest the right ventricular systolic pressure was normal in all patients and controls. At the end of exercise, in 4 patients, values were still normal (40.7 +/- 2.2 mmHg); in the others pathologic values were recorded (59.8 +/- 3.9 mmHg). In the control group values were always normal (35.6 +/- 4.6 mmHg). In our study the saline-enhanced Doppler echocardiography has been demonstrated to be an important diagnostic tool for the noninvasive evaluation of right ventricular systolic pressure, both at rest and during exercise; it could be useful in monitoring the pulmonary vascular damage in patients with PSS.

Early right ventricular systolic dysfunction in patients with systemic sclerosis without pulmonary hypertension: a Doppler Tissue and Speckle Tracking echocardiography study

“…As LV function was not affected, it was difficult for the authors to attribute the abnormalities of RV diastolic function to myocardial fibrosis and ischemia due to intermittent coronary vasospasm alone. They assumed that the most probable cause is mild or early intermittent pulmonary arterial hypertension since Doppler echocardiography may underestimate RV pulmonary pressure calculated from transtricuspid pressure gradient [40-42]. In agreement with Lindqvist et al, we obtained pulmonary arterial pressure from a single measurement at rest.…”

Systemic Sclerosis-associated Pulmonary Arterial Hypertension

“…56 In SSc, studies have suggested a high prevalence of exercise-induced PAH (EIPAH). 57,58 Steen et al 59 evaluated 54 patients with SSc at high risk for PAH and identifi ed EIPAH by TTE in 24. Of these, 19% had resting PAH, and 62% had EIPAH on RHC.…”

Novel Insights into Cardiovascular Regulation in Patients with Chronic Mountain Sickness

“…Thus, during mild exercise, pulmonary-artery pressure was much higher in patients with CMS than in controls (Fig. 6.1b ) and the pressure gradient difference between the 2 groups was more than three times greater than at rest [ 47 ]. During exercise, the arterial oxygen saturation decreased signifi cantly in both groups, but the exercise-induced decrease tended to be greater in patients than in controls.…”

“…To test this hypothesis, we measured pulmonary-artery pressure at rest and during mild semi-supine bicycle exercise in patients suffering from CMS and normal control subjects who were all born and permanently living at 3600-4000 m [ 47 ]. To discriminate between anatomical and functional defects, we measured the carbon monoxide diffusion capacity (a proxy of the extent of the pulmonary microcirculation) and we tested the effects of nitric oxide inhalation on pulmonary-artery pressure in the two groups.…”