Severity of systemic sclerosis-associated pulmonary arterial hypertension in African Americans.

Abstract:

:African Americans (AA) with systemic sclerosis (SSc) have a worse prognosis compared to Americans of European descent (EA). We conducted the current study to test the hypothesis that AA patients with SSc have more severe disease and poorer outcomes compared to EA patients when afflicted with pulmonary arterial hypertension (PAH). We studied 160 consecutive SSc patients with PAH diagnosed by right heart catheterization, comparing demographics, hemodynamics, and outcomes between AA and EA patients. The cohort included 29 AA and 131 EA patients with similar baseline characteristics except for increased prevalence of diffuse SSc in AA. AA patients had worse functional class (FC) (80% FC III-IV vs 53%; p = 0.02), higher brain natriuretic peptide (NT-pro-BNP) (5729 ± 9730 pg/mL vs 1892 ± 2417 pg/mL; p = 0.02), more depressed right ventricular function, a trend toward lower 6-minute walk distance (263 ± 111  m vs 333 ± 110  m; p = 0.07), and worse hemodynamics (cardiac index 1.95 ± 0.58 L/min/m vs 2.62 ± 0.80 L/min/m; pulmonary vascular resistance 10.3 ± 6.2 WU vs 7.6 ± 5.0 WU; p  < 0.05) compared with EA patients. Kaplan-Meier survival estimates for AA and EA patients, respectively, were 62% vs 73% at 2 years and 26% vs 44% at 5 years (p  > 0.05). In conclusion, AA patients with SSc-PAH are more likely to have diffuse SSc and to present with significantly more severe PAH compared with EA patients. AA patients also appear to have poorer survival, though larger studies are needed to investigate this association definitively.

journal_name

Medicine (Baltimore)

journal_title

Medicine

authors

Blanco I,Mathai S,Shafiq M,Boyce D,M Kolb T,Chami H,K Hummers L,Housten T,Chaisson N,L Zaiman A,M Wigley F,J Tedford R,A Kass D,Damico R,E Girgis R,M Hassoun P

doi

10.1097/MD.0000000000000032

subject

Has Abstract

pub_date

2014-07-01 00:00:00

pages

177-185

issue

5

eissn

0025-7974

issn

1536-5964

pii

00005792-201407020-00001

journal_volume

93

pub_type

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