Is relevant to add stress echocardiography with semi-supine bicycle at the screening of pulmonary hypertension in systemic sclerosis patients?

Funding Acknowledgements Type of funding sources: None. Introduction Pulmonary hypertension (PH) is the leading cause of death in systemic sclerosis, with a 50% mortality rate within three years of PH diagnosis. The 3-year survival of patients with SSc and PH is estimated to be 56% compared with 94% for those without PH.(1,2). Patients with SSc are at risk of developing group 1 to 3 PH. Detection of PH with echocardiography at rest remains the essential clinical tool; several studies suggested that in patients with SSc, an even earlier change would be the abnormal increase in pulmonary pressures with exercise. (3–6) Purpose Exercise-induced pulmonary hypertension may represent an early but clinically relevant phase in the spectrum of pulmonary vascular disease. On the other hand, increases in mean pulmonary artery pressure on exercise echocardiography can be followed over time, indicating the progression of the pulmonary vascular disease before PH. Methods Observational, prospective, cross-sectional, and analytical study. A basal transthoracic echocardiogram (TTE) and physical stress echocardiogram test were performed, and a TTE follow-up at four years. Results 40 patients. A follow-up was 48 months ED 6 months. Women (93%). Mean age of 49.8 ED 11.4 years. 9.8% of the patients had systemic arterial hypertension; no patient had diabetes mellitus or other chronic-degenerative diseases. 28 (68.3%) patients had the limited cutaneous variety, and 13 (31.7%) patients had the diffuse type. In the basal TTE at the first visit, all had a low probability of presenting pulmonary hypertension; in the follow-up echocardiogram, 11 (26.8%) patients showed a high likelihood of pulmonary hypertension. TTE with a cycle ergometer at first visit: 19 (46.3%) patients presented PSAP >50 mmHg, 16 (39%) patients gave DeltaPSAP >24 mmHg, 19 (46.3%) patients showed a relationship mPAP >30 mmHg + PVR > 3 mmHg/L/min The correlation between stress test variables and the high probability of pulmonary hypertension at follow-up was PSAP>50 mmHg exercise (r 0.58, p<0.001). Delta PSAP >24 mmHg exercise(r 0.40, p 0.011). mPAP>30 mmHg + PVR>3 mmHg/L/min exercises (r 0.45, p 0.003). PVR and >3 mmHg/L/min (r 0.15, p 0.310). Conclusion(s) Exercise-induced pulmonary hypertension is a promising tool in screening patients with systemic sclerosis for the detection of pulmonary hypertension at earlier preclinical stages. Identifying patients with closer follow-up for TTE at rest every 3 to 6 months and not every year as suggested in this disease.