Exercise hemodynamics for the diagnosis of diastolic dysfunction in dyspneic patients with systemic sclerosis

Anne Graham Cummiskey, Amit Segev, Michael Segel, Jonathan Buber, Victor Guetta, Israel M. Barbash, Dan Elian, Elad Asher, Ori Vaturi, Paul Fefer

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Previous studies have demonstrated the utility of exercise hemodynamics during right heart catheterization (RHC) in the diagnosis of diastolic dysfunction (DD). Little data exists regarding exercise hemodynamics during RHC in symptomatic systemic sclerosis (SSc) patients. Objectives: To assess the added diagnostic value of using exercise hemodynamics during RHC in assessment of patients with symptomatic SSc. Methods: We performed 22 RHCs in 17 SSc patients with dyspnea and/or pulmonary arterial hypertension (PAH). Exercise was performed in 15 RHCs using isotonic arm exercises while holding a 1 kg weight in each hand. Measurements of pulmonary arterial pressure (PAP), pulmonary arterial wedge pressure (PAWP), and cardiac output (CO) were taken at rest and during peak exercise. Results: Normal resting RHC (PAP 22 ± 3 mmHg, PAWP 11 ± 3 mmHg) was found in seven cases. Of these, exercise induced elevation in PAP was found in three (38 ± 7 mmHg), and exercise induced elevation in PAWP was found in four (24 ± 6 mmHg). Elevated resting PAP was found in 15 (41 ± 11 mmHg) with minor changes in exercise. Of the 22 RHCs, elevation of the PAWP was found in 11 (50%), half of which were in response to exercise. Conclusions: In symptomatic SSc patients, exercise hemodynamics provides important information on diastolic dysfunction that is not available with non-invasive testing. Findings on exercise RHC can explain patient symptoms in up to 50% of cases. Earlier and more accurate diagnosis of patient symptoms can aid in tailoring the correct therapy for each.

Original languageEnglish
Pages (from-to)245-249
Number of pages5
JournalIsrael Medical Association Journal
Volume20
Issue number4
StatePublished - Apr 2018

Keywords

  • Diastolic dysfunction
  • Exercise hemodynamics
  • Pulmonary hypertension
  • Right heart catheterization (RHC)
  • Systemic sclerosis (SSc)

Fingerprint

Dive into the research topics of 'Exercise hemodynamics for the diagnosis of diastolic dysfunction in dyspneic patients with systemic sclerosis'. Together they form a unique fingerprint.

Cite this