Objective. Cardiopulmonary exercise test (CPET) is a widely used examination to predict
the prognosis of many chronic pulmonary diseases, and it has also been tested in systemic
sclerosis (SSc) with a focus on the development of pulmonary hypertension. CPET is
a highly informative non-invasive tool that provides a more complex information than
conventional lung function tests to predict the course of cardiopulmonary diseases,
as it provides a general overview of the aerobic metabolism, influenced by pulmonary,
cardiovascular and peripheral muscle function. The purpose of this investigation was
to assess if the progression and the development of poor overall disease outcome in
SSc can be predicted by this method. Methods. Twenty-nine SSc patients were investigated
prospectively with standard follow-up plus CPET for a mean of 3.7 years to match the
results of conventional evaluation modalities and CPET. A composite end-point of several
serious outcomes reflecting SSc-related vascular and cardiopulmonary damage was set
up, and the predictive value of and correlations between the CPET parameters and resting
lung function and echocardiography variables were assessed. Results. None of the clinical
parameters, resting lung function or echocardiographic test results proved to be predictive
of the development of the endpoint of poor prognosis in this cohort. In contrast,
several CPET parameters were found to discriminate between SSc patients with or without
adverse outcome. The detection of desaturation (at any CPET test) was associated with
a higher risk of poor prognosis (OR: 5265). VO2 and VE/VCO, at baseline correlated
with the annual decrease in FVC, anaerobic threshold with the development of digital
ulcers, and VEI VO2 with the increase in pulmonary arterial pressure. Conclusion.
Several CPET parameters obtained at the beginning of follow-up are informative of
the appearance of various adverse end-points. CPET is a feasible examination in the
care of SSc patients and provides excess information to current standard follow-up
examinations.
