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Overlap of coronary disease and pulmonary arterial hypertension in systemic sclerosis
  1. András Komócsi (andras.komocsi{at}aok.pte.hu)
  1. Heart Institute, Faculty of Medicine, University of Pécs, Hungary, Hungary
    1. Tünde Pintér (tunde.pinter{at}index.hu)
    1. Heart Institute, Faculty of Medicine, University of Pécs, Hungary, Hungary
      1. Réka Faludi (reka.faludi{at}aok.pte.hu)
      1. Heart Institute, Faculty of Medicine, University of Pécs, Hungary, Hungary
        1. Balázs Magyari (balazs.magyari{at}aok.pte.hu)
        1. Heart Institute, Faculty of Medicine, University of Pécs, Hungary, Hungary
          1. János Bozó (janos.bozo{at}aok.pte.hu)
          1. Heart Institute, Faculty of Medicine, University of Pécs, Hungary, Hungary
            1. Gábor Kumánovics (gabor.kumanovics{at}aok.pte.hu)
            1. Department of Immunology and Rheumatology, University Pécs, Hungary
              1. Tünde Minier (tunde.minier{at}aok.pte.hu)
              1. Department of Immunology and Rheumatology, University Pécs, Hungary
                1. Judit Radics (judit.radics{at}aok.pte.hu)
                1. Department of Immunology and Rheumatology, University Pécs, Hungary
                  1. László Czirják (laszlo.czirjak{at}aok.pte.hu)
                  1. Department of Immunology and Rheumatology, University Pécs, Hungary

                    Abstract

                    Pulmonary arterial hypertension (PAH) is a common complication of systemic sclerosis (SSc). Symptoms of coronary artery disease (CAD) and PAH are closely related and cardiac catheterization is needed to confirm their diagnosis.

                    Objectives: Investigation of the extent of overlap between CAD and PAH in patients with SSc. Methods: Based on non-invasive investigations, 20 patients out of 120 were supposed to have PAH ('suspected PAH' group). Another 10 patients showed the signs of coronary disease ('suspected CAD' Group). In these 30 patients, both right heart catheterization and coronary angiography were performed, and the coronary flow reserve (CFR) was assessed by thermodilution technique.

                    Results: In the 'suspected PAH' and the 'suspected CAD' groups, PAH was found in 12/20 and 2/10 cases, coronary artery stenosis was in 9/20 and 6/10 cases. Severely reduced CFR was revealed in 7/20 and 3/10 cases, respectively.

                    Conclusions: PAH, CAD, and reduced CFR show a considerable overlap in symptomatic SSc patients. The current non-invasive investigations are neither sensitive nor specific enough to make an appropriate distinction between these different disease manifestations. A more invasive approach, such as coronary angiography at the initial catheterization, is required to properly characterize and treat the different forms of cardiac involvement in SSc.

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