Exercise during cardiac catheterization distinguishes between pulmonary and left ventricular causes of dyspnea in systemic sclerosis patients.

Objective The cause for shortness of breath among systemic sclerosis (SSc) patients is often lacking. We sought to characterize the hemodynamics of these patients by using simple isotonic arm exercise during cardiac catheterization. Methods Catheterization was performed in 173 SSc patients when resting echocardiographic pulmonary systolic pressures were <40 but >40mmHg post stress. Patients with resting mean pulmonary arterial pressures (mPAP)25 and pulmonary arterial wedge pressures (PAWP)15mmHg exercised with 1-pound hand weights. Normal exercise was defined as a change in mPAP divided by the change in cardiac output (CO) (mPAP/CO) ratio2 for patients <50 years (3 for >50). An abnormal mPAP/CO ratio, an exercise transpulmonary gradient (TPG)15, a PAWP<20, a TPG>PAWP and a pulmonary vascular resistance (PVR) which increased defined exercise-induced pulmonary arterial hypertension (EIPAH). An abnormal mPAP/CO ratio, an exercise TPG<15, a PAWP20, a TPG更多