Clinical case of delayed systemic sclerosis and pulmonary arterial hypertension diagnostics

Authors

  • L. I. Vasylieva SI “Dnepropetrovsk Medical Academy of Health Ministry of Ukraine”, Dnipro,
  • Ye. D. Yehudina SI “Dnepropetrovsk Medical Academy of Health Ministry of Ukraine”, Dnipro,
  • O. S. Kalashnykova SI “Dnepropetrovsk Medical Academy of Health Ministry of Ukraine”, Dnipro,

DOI:

https://doi.org/10.14739/2310-1210.2019.2.161515

Keywords:

pulmonary hypertension, systemic sclerosis, cardiac catheterization

Abstract

 

Pulmonary hypertension is a frequent and severe complication of systemic sclerosis (SSc). SSc-PAH patients have a worse prognosis than patients with idiopathic PAH. We report a case of a patient with delayed SSc and PAH diagnostics. Limited SSc was established in a 61-year-woman with 20 years of Raynaud’s syndrome anamnesis. But diagnosis of SSc-PAH was determined in severe and late symptomatic stage with signs of right heart congestion, NYHA III FC and mPAP 48 mmHg. This emphasizes the need for clinicians to be aware of limited SSc and have a high index of PH suspicion in such patients.

References

Chifflot, H., Fautrel, B., Sordet, C., Chatelus, E., & Sibilia, J. (2008) Incidence and Prevalence of Systemic Sclerosis: A systematic literature review. Semin Arthritis Rheum., 37(4), 223–35. doi: 10.1016/j.semarthrit.2007.05.003

Abu-Shakra, M., & Lee, P. (1995) Mortality in systemic sclerosis: a comparison with the general population. J. Rheumatol., 22(11), 2100–2102.

Hao, Y., Thakkar, V., Stevens, W., Morrisroe, K., Prior, D., Rabusa, C., et al. (2015) A comparison of the predictive accuracy of three screening models for pulmonary arterial hypertension in systemic sclerosis. Arthritis. Res. Ther., 17, 7. doi: 10.1186/s13075-015-0517-5

Muangchan, C., Baron, M., & Pope, J. (2013) The 15% rule in scleroderma: the frequency of severe organ complications in systemic sclerosis: A systematic review. J. Rheumatol., 40(9), 1545–56. doi: 10.3899/jrheum.121380

Fisher, M. R., Mathai, S. C., Champion, H. C., Girgis, R. E., Housten-Harris, T., Hummers, L., et al. (2006) Clinical differences between idiopathic and scleroderma-related pulmonary hypertension. Arthritis. Rheum., 54(9), 3043–3050. doi: 10.1002/art.22069

Kawut, S. M., Taichman, D. B., Archer-Chicko, C. L., Palevsky, H. I., Kimmel, S. E., et al. (2003) Hemodynamics and survival in patients with pulmonary arterial hypertension related to systemic sclerosis. Chest, 123(2), 344–350. doi: 10.1378/chest.123.2.344

D’Alonzo, G. E., Barst, R. J., Ayres, S. M., Bergofsky, E. H., Brundage, B. H., Detre, K. M., et al. (1991) Survival in patients with primary pulmonary hypertension. Results from a national prospective registry. Ann Intern Med., 115(5), 343–9.

Steen, V. D., Lucas, M., Fertig, N., & Medsger, Jr T. A. (2007) Pulmonary arterial hypertension and severe pulmonary fibrosis in systemic sclerosis patients with a nucleolar antibody. J. Rheumatol., 34, 2230–5.

Coghlan, J.G., Denton, C. P., Grünig, E., Bonderman, D., Distler, O., Khanna, D., et al. (2014) Evidence-based detection of pulmonary arterial hypertension in systemic sclerosis: the DETECT study. Ann. Rheum. Dis., 73(7), 1340–9. doi: 10.1136/annrheumdis-2013-203301

Chung, L., Domsic, R. T., Lingala, B., Alkassab, F., Bolster, M., Csuka, M. E., et al. (2014) Survival and predictors of mortality in systemic sclerosis-associated pulmonary arterial hypertension: outcomes from the pulmonary hypertension assessment and recognition of outcomes in scleroderma registry. Arthritis Care Res., 66(3), 489–95. doi: 10.1002/acr.22121

Semenov, V., Kuryata, O., & Lysunets, T. (2018) Clinical pattern of systemic sclerosis in Central Ukraine. Association between clinical manifestations of systemic sclerosis and hypertension. Reumatologia, 56(1), 24–30. doi: 10.5114/reum.2018.74745

Galiè, N., Humbert, M., Vachiery, J. L., Gibbs, S., Lang, I., Torbicki, A., et al. (2015) 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur. Respir. J., 46(4), 903–75. doi: 10.1183/13993003.01032-2015

Simonneau, G. (2018) PH haemodynamic definitions and clinical classifications and characteristics of specific PAH subgroups. Materials of 6 World Symposium on Pulmonary Hypertension. Nice.

Coghlan, J. G., Wolf, M., Distler, O., Denton, C. P., Doelberg, M., Harutyunova, S., et al. (2018) Incidence of pulmonary hypertension and determining factors in patients with systemic sclerosis. Eur. Respir. J., 51(4), pii: 1701197. doi: 10.1183/13993003.01197-2017

Valerio, C. J., Schreiber, B. E., Handler, C. E., Denton, C. P., & Coghlan, J. G. (2013) Borderline Mean Pulmonary Artery Pressure in Patients With Systemic Sclerosis: Transpulmonary Gradient Predicts Risk of Developing Pulmonary Hypertension. Arthritis and Rheumatology, 65(4), 1074–84. doi: 10.1002/art.37838

Fox, B. D., Shimony, A., Langleben, D., Hirsch, A., Rudski, L., Schlesinger, R., et al. (2013) .High prevalence of occult left heart disease in scleroderma-pulmonary hypertension. Eur. Respir. J., 42(4), 1083–91. doi: 10.1183/09031936.00091212

Avouac, J., Airò, P., Meune, C., Beretta, L., Dieude, P., Caramaschi, P., et al. (2010) Prevalence of pulmonary hypertension in systemic sclerosis in European Caucasians and metaanalysis of 5 studies. J. Rheumatol., 37(11), 2290–8. doi: 10.3899/jrheum.100245

Tedford, R. J., Hassoun, P. M., Mathai, S. C., Girgis, R. E., Russell, S. D., Thiemann, D. R., et al. (2012) Pulmonary capillary wedge pressure augments right ventricular pulsatile loading. Circulation., 125(2), 289–97. doi: 10.1161/CIRCULATIONAHA.111.051540

Dai, Z., & Matsui, Y. (2014) Pulmonary veno-occlusive disease: an 80-year-old mystery. Respiration., 88(2), 148–57. doi: 10.1159/000359973

Montani, D., Achouh, L., Dorfmüller, P., Le Pavec, J., Sztrymf, B., Tchérakian, C., et al. (2008) Pulmonary veno-occlusive disease: clinical, functional, radiologic, and hemodynamic characteristics and outcome of 24 cases confirmed by histology. Medicine (Baltimore), 87(4), 220–33. doi: 10.1097/MD.0b013e31818193bb

Eyries, M., Montani, D., Girerd, B., Perret, C., Leroy, A., Lonjou, C., et al. (2014) EIF2AK4 mutations cause pulmonary veno-occlusive disease, a recessive form of pulmonary hypertension. Nat Genet., 46(1), 65–9. doi: 10.1038/ng.2844

Lammi, M. R., Saketkoo, L. A., Gordon, J. K., & Steen, V. D. (2018) Changes in hemodynamic classification over time are common in systemic sclerosis-associated pulmonary hypertension: insights from the PHAROS cohort. Pulmonary Circulation., 8(2), 2045893218757404. doi: 10.1177/2045893218757404

Frost, A. E., Farber, H. W., Barst, R. J., Miller, D. P., Elliott, C. G., & McGoon, M. D. (2013) Demographics and outcomes of patients diagnosed with pulmonary hypertension with pulmonary capillary wedge pressures 16 to 18 mm Hg: insights from the REVEAL Registry. Chest., 143(1), 185–195. doi: 10.1378/chest.11-1387

Ciurzynski, M. B. P., Bienias, P., Lichodziejewska, B., Szewczyk, A., Glińska-Wielochowska, M., Jankowski, K., et al. (2008) Assessment of left and right ventricular diastolic function in patients with systemic sclerosis. Kardiol. Pol., 66, 269–276.

Lazar, J. M., Flores, A. R., Grandis, D. J., Orie, J. E., & Schulman, D. S. (1993) Effects of chronic right ventricular pressure overload on left ventricular diastolic function. Am J Cardiol., 72(15), 1179–82. https://doi.org/10.1016/0002-9149(93)90990-T

Rubenfire, M., Huffman, M. D., Krishnan, S., Seibold, J. R., Schiopu, E., & McLaughlin, V. V. (2013) Survival in systemic sclerosis with pulmonary arterial hypertension has not improved in the modern era. Chest., 144(4), 1282–1290. doi: 10.1378/chest.12-0653

DETECT - DETECTion of PAH in SSC. Retrieve from http://detect-pah.com.

Thibodeau, J. T., Turer, A. T., Gualano, S. K., Ayers, C. R., Velez-Martinez, M., Mishkin, J. D., et al. (2014) Characterization of a novel symptom of advanced heart failure: bendopnea. JACC Heart Fail., 2(1), 24–31. doi: 10.1016/j.jchf.2013.07.009

Brandon, N., & Mehra, M. R. (2013) «Flexo-dyspnea»: A novel clinical observation in the heart failure syndrome. J Heart Lung Transplant., 32(8), 844–5. doi: 10.1016/j.healun.2013.06.006

van den Hoogen, F., Khanna, D., Fransen, J., Johnson, S. R., Baron, M., Tyndall, A., et al. (2013) 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European league against rheumatism collaborative initiative. Ann Rheum Dis., 72(11), 1747–55. doi: 10.1136/annrheumdis-2013-204424

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1.
Vasylieva LI, Yehudina YD, Kalashnykova OS. Clinical case of delayed systemic sclerosis and pulmonary arterial hypertension diagnostics. Zaporozhye Medical Journal [Internet]. 2019Apr.2 [cited 2024Nov.23];(2). Available from: http://zmj.zsmu.edu.ua/article/view/161515

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Case Reports