TOPLINE: 

Among patients with systemic sclerosis (SSc) and exercise intolerance, 44% exhibited exercise-induced pulmonary hypertension (PH), with most showing signs of heart failure with preserved ejection fraction (HFpEF). Decreased nailfold capillary density and palpitations emerged as key indicators.

METHODOLOGY:

• Researchers conducted a single-center retrospective observational study from April 2022 to April 2024, enrolling 50 patients with SSc who reported exercise intolerance, to determine the prevalence of exercise-induced PH.
• Right heart catheterization was performed at rest in all patients for the diagnosis of PH on the basis of criteria for precapillary PH; those without a diagnosis underwent exercise right heart catheterization to assess exercise-induced PH. Patients who did not meet any of the criteria comprised the non-PH group.
• Additional clinical assessments included physical examination, biochemical testing, transthoracic echocardiography, and respiratory function tests, which were compared across the three groups.
• Nailfold videocapillaroscopy was used to evaluate capillary morphology and quantify capillary density (vessel count per mm) in the central nailfold of fingers 2-5 of both hands.
• Characteristics of patients with SSc and exercise-induced PH and associated factors were also assessed.

TAKEAWAY:

• Overall, 30.0% of patients with SSc and exercise intolerance were diagnosed with PH at rest, and 44.0% were diagnosed with exercise-induced PH.
• The PH and exercise-induced PH groups had a significantly lower nailfold capillary density than the non-PH group (P = .01 and P = .001, respectively). By setting a threshold of seven capillaries per mm, 77.8% of the patients were diagnosed with exercise-induced PH (P = .0017).
• The proportion of patients meeting the criteria for HFpEF prediction scores of 2 or more increased with disease progression, with 68.2% in the exercise-induced PH group and 93.3% in the PH group meeting the criteria.
• Factors such as palpitations during exertion and nailfold capillary density ≤ seven per mm were predictors of exercise-induced PH in multivariate analysis (odds ratio [OR], 5.98; 95% CI, 1.08-41.6 and OR, 7.47; 95% CI, 1.04-75.0, respectively). These two factors, along with exertional dyspnea, proved highly predictive, with 87.5% of patients who met the three criteria being positive for exercise-induced PH.

IN PRACTICE:

"This study revealed that exertional dyspnea, exertional palpitations, and decreased nailfold capillary density (≤ seven/mm) serve as useful indicator for considering exercise [right heart catheterization]. Palpitations are not a characteristic finding of PH and are not sufficient to suspect PH on their own; however, when combined with other clinical features, they may serve as a useful indicator. All of these can be assessed quickly, making them viable for use in a daily clinical practice," the authors wrote.

SOURCE: 

This study was led by Katsuhide Kusaka, University of Occupational and Environmental Health in Kitakyushu, Japan. It was published online on August 26, 2025, in Arthritis Research & Therapy.

LIMITATIONS: 

The sample size was relatively small. While interstitial lung disease was assessed, the prevalence of other pulmonary comorbidities was not evaluated. The potential progression of non-PH and exercise-induced PH was not investigated through follow-up evaluations.

DISCLOSURES: 

No funding was received for this study. Some authors reported receiving research grants, speaking fees, consulting fees, lecture fees, and/or honoraria from multiple pharmaceutical and biopharmaceutical companies, including Eli Lilly, GlaxoSmithKline, and Bristol Myers Squibb. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.