• Sangmee Bae, Rajeev Saggar, Marcy B Bolster, Lorinda Chung, Mary Ellen Csuka, Chris Derk, Robyn Domsic, Aryeh Fischer, Tracy Frech, Avram Goldberg, Monique Hinchcliff, Vivien Hsu, Laura Hummers, Elena Schiopu, Maureen D Mayes, Vallerie McLaughlin, Jerry Molitor, Nausheen Naz, Daniel E Furst, Paul Maranian, Virginia Steen, and Dinesh Khanna.
• Department of Internal Medicine, University of California, Los Angeles, California, USA.
• Ann. Rheum. Dis. 2012 Aug 1;71(8):1335-42.

BackgroundPatients with normal (mean pulmonary arterial pressure (mPAP) ≤20 mm Hg) and borderline mean pulmonary pressures (21-24 mm Hg) are "at risk" of developing pulmonary hypertension (PH). The objectives of this analysis were to examine the baseline characteristics in systemic sclerosis (SSc) with normal and borderline mPAP and to explore long-term outcomes in SSc patients with borderline mPAP versus normal haemodynamics.MethodsPHAROS is a multicentre prospective longitudinal cohort of patients with SSc "at risk" or recently diagnosed with resting PH on right heart catheterisation (RHC). Baseline clinical characteristics, pulmonary function tests, high-resolution CT, 2-dimensional echocardiogram and RHC results were analysed in normal and borderline mPAP groups.Results206 patients underwent RHC (results showed 35 normal, 28 borderline mPAP, 143 resting PH). There were no differences in the baseline demographics. Patients in the borderline mPAP group were more likely to have restrictive lung disease (67% vs 30%), fibrosis on high-resolution CT and a higher estimated right ventricular systolic pressure on echocardiogram (46.3 vs 36.2 mm Hg; p<0.05) than patients with normal haemodynamics. RHC revealed higher pulmonary vascular resistance and more elevated mPAP on exercise (≥30; 88% vs 56%) in the borderline mPAP group (p<0.05 for both). Patients were followed for a mean of 25.7 months and 24 patients had a repeat RHC during this period. During follow-up, 55% of the borderline mPAP group and 32% of the normal group developed resting PH (p=NS).ConclusionsPatients with borderline mPAP have a greater prevalence of abnormal lung physiology, pulmonary fibrosis and the presence of exercise mPAP ≥30 mm Hg.

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