• Vivien M Hsu, Lorinda Chung, Laura K Hummers, Fredrick Wigley, Robert Simms, Marcy Bolster, Rick Silver, Aryeh Fischer, Monique E Hinchcliff, John Varga, Avram Z Goldberg, Chris T Derk, Elena Schiopu, Dinesh Khanna, Lee S Shapiro, Robyn T Domsic, Thomas Medsger, Maureen D Mayes, Daniel Furst, Mary E Csuka, Jerry A Molitor, Firas Alkassab, and Virginia D Steen.
• Department of Medicine, Division of Rheumatology, Adult Clinical Research Center, Rutgers-RWJ Medical School, Acute Care Building, 51 French St, New Brunswick, NJ 08903. Electronic address: hsuvm@rwjms.rutgers.edu.
• Semin. Arthritis Rheum. 2014 Aug 1; 44 (1): 55-62.

ObjectivesPHAROS registry is a prospective longitudinal cohort study to understand the natural history of pulmonary hypertension (PH) in systemic sclerosis (SSc).Methods"At-risk" pulmonary arterial hypertension (PAH) is defined by these entry criteria: echocardiogram (echo) systolic pulmonary arterial pressure (sPAP) >40 mmHg, diffusion lung capacity of carbon monoxide (DLco) <55% predicted, or ratio of percentage forced vital capacity (FVC)/percentage DLco >1.6, as measured by pulmonary function testing (PFT). Patients were followed up annually and right heart catheterization (RHC) performed if PH was suspected. We used descriptive statistics and Kaplan-Meier estimate of time to PH diagnosis.ResultsA total of 251 "at-risk" subjects were enrolled between 2005 and 2012 and followed up for mean of 2.5 ± 1.2 years. The mean age at entry was 56.7 ± 11.0 and disease duration was 9.9 ± 8.7 years. Overall, 82 patients had RHC, and 35 were confirmed to have new PH. There were no differences in age, gender, SSc subtypes, antibodies, and disease duration between the "at-risk" and new PH groups. Using Kaplan-Meier survival, the time to PH was 10% at 2 years, 13% at 3 years, and 25% at 5 years. Most new PH patients at entry met the PFT criteria (76%), had significantly higher sPAP (p = 0.013), had shorter 6-min walk distance, and had exercise-induced hypoxia (p = 0.003) than "at-risk" PAH group.ConclusionsA low DLco, high FVC/DLco, exercise-induced hypoxia and entry echo sPAP > 40 were strongly associated with future PH, though RHC was necessary to confirm PH. This ongoing prospective study confirms that these high-risk factors do predict future PH.Copyright © 2014 Elsevier Inc. All rights reserved.

21 keywords...

hide…