NONINVASIVE EVALUATION OF RIGHT VENTRICLE SYSTOLIC PRESSURE DURING DYNAMIC EXERCISE BY SALINE-ENHANCED DOPPLER-ECHOCARDIOGRAPHY IN PROGRESSIVE SYSTEMIC-SCLEROSIS

Progressive systemic sclerosis (PSS) is characterized in its first pha ses by vascular damage. Lungs are involved in two thirds of patients w ith initial progressive destruction of the capillary bed and consequen t reduction of the functional reserve, which may lead to hypertension of the pulmonary circulation. For these reasons it is of great interes t to have early information about the pressure of the pulmonary circul ation, both at rest and during exercise, to follow the progression and the evolution of the illness independently from subjective symptoms. The aim of the study was to evaluate by a noninvasive method, saline-e nhanced Doppler echocardiography, the behavior of the right ventricula r systolic pressure in patients with PSS, at rest and during exercise, without clear instrumental or clinical signs of pulmonary involvement at rest. Nine patients (7 women and 2 men) with PSS, aged 55.7 +/-8.7 years, and 9 control subjects were evaluated. All patients had normal pulmonary pressure at rest and negative history for effort dyspnea. S ubjects underwent Doppler echocardiographic examination at rest and du ring exercise. Right ventricular systolic pressure was evaluated by sa line-enhanced Doppler technique, at rest and throughout exercise. At r est the right ventricular systolic pressure was normal in all patients and controls. At the end of exercise, in 4 patients, values were stil l normal (40.7 +/-2.2 mmHg); in the others pathologic values were reco rded (59.8 +/-3.9 mmHg). In the control group values were always norma l (35.6 +/-4.6 mmHg). In our study the saline-enhanced Doppler echocar diography has been demonstrated to be an important diagnostic tool for the noninvasive evaluation of right ventricular systolic pressure, bo th at rest and during exercise; it could be useful in monitoring the p ulmonary vascular damage in patients with PSS.