SEARCH FOR CLINICAL PREDICTORS OF PULMONARY HYPERTENSION IN PATIENTS WITH SYSTEMIC SCLEROSIS

Abstract

Pulmonary hypertension (PH) in patients with systemic sclerosis (SSc) is associated with an unfavorable prognosis. The scope of investigations necessary to detect PH, the complexity of its diagnostic algorithms for routine use, as well as the impossibility to apply the existing algorithms for all PH variants increase the relevance of searching for novel PH predictors in patients with SSc.Objective: to reveal the relationship of capillary structural changes to the clinical and immunological subtype of SSc, disease activity, and risk for PH.Subjects and methods. The trial enrolled 57 patients with SSc. The investigators evaluated the activity of the disease, the extent of skin lesion, the fluorescent pattern and titer of antinuclear factor, and the level of N-terminal brain natriuretic propeptide. All the patients underwent nailfold videocapillaroscopy, a comprehensive assessment of external respiratory functions, and echocardiography. When there were indirect signs of PH, right heart catheterization was performed for its verification.Results and discussion. PH was detected in 10 of the 57 patients enrolled in the trial. The patients with PH were significantly older than those without PH (61±7 and 53±10 years, respectively; p=0.036); there were also differences between these groups in the semiquantitative assessment of nailfold capillary alterations (p<0.05) and in the signs of right cardiac remodeling (p <0.05). The Rodnan skin score was found to be related to right atrial area (r=0.506; p=0.019) and pulmonary artery diameter (r=0.482; p=0.027). It has been shown that age older than 60 years (p=0.001), reduced capillary bed density (p=0.033), and lower lung diffusing capacity (p=0.024) may be an additional criterion increasing the probability of PH. In localized cutaneous SSc, the Rodman skin score correlated with right atrial area (r=0.582; p=0.009), right ventricular dimensions in parasternal (r=0.517; p=0.023) and basal (r=0.697; p=0.001) sections, and with pulmonary artery diameter (r=0.816; p<0.001).Conclusion. In localized cutaneous SSc, nailfold capillaroscopy can be used along with the Rodnan skin score to assess PH probability.

Keywords

• systemic sclerosis
• pulmonary hypertension
• capillaroscopy