TY - JOUR T1 - Scleroderma lung disease: Detection of pulmonary hypertension using pulmonary function tests is problematic in patients with emphysema JF - European Respiratory Journal JO - Eur Respir J VL - 42 IS - Suppl 57 SP - P5115 AU - Katerina Antoniou AU - George Margaritopoulos AU - David Hansell AU - Sujal Desai AU - Toby Maher AU - Elizabeth Renzoni AU - Nikolaos Siafakas AU - Athol Wells Y1 - 2013/09/01 UR - http://erj.ersjournals.com/content/42/Suppl_57/P5115.abstract N2 - In a large cohort of SSc patients with little or no lung disease, an elevated FVC/DLco ratio of over 1.60 was one of the three variables considered to justify the performance of a right heart study. To determine the prevalence of an increased FVC/DLco ratio above 1.60 in a large consecutive cohort of patients with SScILD, and the frequency with which an elevated FVC/DLco ratio is ascribable to concurrent emphysema. Results: 343 patients with SSc-ILD. Emphysema present in 41/343 cases (12%). Pulmonary Function tests have shown: FEV1: 75.2 +/ 19.4, FVC : 75.9 +/ 21.9, DLco : 51.6 +/ 17.9, FVC/DLco ratio: 1.57 +/ 0.50. After adjustment for the extent of fibrosis on HRCT, the presence of emphysema was associated with a reduction in DLco (decrease of 12.8%; 95% CI 8.1%, 17.5%; p<0.0005) and an increase in the FVC/DLco ratio (increase of 0.60; 95% CI 0.46, 0.74; p<0.0005). In the whole cohort, an FVC/DLco ratio of >1.6 was seen in 119/343 patients and was more prevalent in patients with concurrent emphysema (33/41, 80%) than in the remaining cases (86/302, 28%), p<0.0005. The presence of emphysema (OR 8.4; 95% CI 2.4, 29.4; p<0.001) and the presence of pulmonary hypertension (OR 4.6; 95% CI 2.0, 10.6; p<0.0005) were indeterminate determinants of an FVC/DLco ratio >1.6. The presence of emphysema (RC 0.41; 95% CI 0.19, 0.62; p<0.0005) and the presence of pulmonary hypertension (RC 0.30; 95% CI 0.15, 0.45; p<0.0005) were independent determinants of the FVC/DLco ratio when examined as a continuous variable. The presence of concurrent emphysema is a major confounder when the FVC/DLco ratio is used to identify a high liklelihood of underlying PH. ER -