DDimer and Pulmonary Arterial Hypertension

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Slide 1 : D-Dimer and Pulmonary Arterial Hypertension in Systemic SclerosisSongsak Kiatchoosakun MD*,Wichai Ungkasekvinai MD*, Chaiyasit Wonvipaporn MD*,Pyatat Tatsanavivat MD*, Chingching Foocharoen MD**,Siraphop Suwannaroj MD**, Ratanavadee Nanagara MD*** Division of Cardiology, Department of Medicine, Khon Kaen University, Khon Kaen** Division of Allergy Immunology and Rheumatology, Department of Medicine, Khon Kaen University, Khon Kaen J Med Assoc Thai 2007; 90: 2024-9
Slide 2 : Introduction Pulmonary artery hypertension (PAH) is the cause of considerable morbidity and mortality in patients with systemic sclerosis (SSc) The pathological findings suggest that microvascular thrombosis may play a significant role in idiopathic PAH The authors hypothesized that the level of D-dimer may be used as a biomarker for indicating the severity of PAH in patients with SSc and may be helpful in identifying SSc patients at risk of PAH
Slide 3 : Material and Methods Patients This prospective study was conducted between May 2005 and July 2006 at Srinagarind Hospital, Khon Kaen University, Thailand Consecutive patients fulfilling the American College of Rheumatology (ACR) criteria for the diagnosis of systemic sclerosis were enrolled
Slide 4 : Material and Methods Echocardiography and d-dimer Right ventricular systolic pressure (RVSP) was measured by continuous wave Doppler echocardiography using the modified Bernoulli equation and PAH was considered present if RVSP exceeded 36 mmHg The severity of PAH was classified as mild (36 to 45 mmHg), moderate (46 to 55 mmHg) or severe (> 56 mmHg) D-dimer was assayed as recommended by the kit manufacturer using the commercial kit and assay (D- dimer Plus)
Slide 5 : Statistical Analysis The continuous variables are presented here as means + SD, and categorical variables are described with frequencies and percentages The respective continuous and categorical variables were compared using the t and ?2 test, as appropriate The correlation between RVSP and the d-dimer level was assessed using Pearson’s correlation coefficient (r) A p-value of < 0.05 was considered statistically significant
Slide 6 : Results One hundred and fifty five patients with systemic sclerosis were enrolled in the present study but 129 patients satisfied the study protocols and were retained for analysis Overall, 47 patients (36.4%) had PAH by Doppler echocardiography including 32 (68.1%) mild, nine (19.1) moderate and six (12.8%) severe The clinical characteristics including Rodnan’ score and subtype of SSc between patients with and without PAH were not different There was no significant correlation between D-dimer and RVSP (r = 0.02, p = 0.82)
Slide 7 : Conclusion The present study demonstrated that the D-dimmer level is not associated with the level of pulmonary artery pressure in patients with systemic sclerosis, indicating that microvascular thrombosis may not play a significant role in the pathogenesis of PAH in patients with systemic sclerosis

 


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