Chest wall muscle area, ventilatory efficiency and exercise capacity in systemic sclerosis

Nicola Galea; Amalia Colalillo; Serena Paciulli; Chiara Pellicano; Martina Giannetti; Emanuele Possente; Gregorino Paone; Antonella Romaniello; Maurizio Muscaritoli; Edoardo Rosato; Antonietta Gigante

doi:10.1007/s11739-024-03751-z

Chest wall muscle area, ventilatory efficiency and exercise capacity in systemic sclerosis

Intern Emerg Med. 2024 Sep 17. doi: 10.1007/s11739-024-03751-z. Online ahead of print.

Affiliations

¹ Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy.
² Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
³ Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic, Geriatric Sciences La Sapienza University of Rome, Rome, Italy.
⁴ Division of Cardiology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
⁵ Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy. antonietta.gigante@uniroma1.it.

PMID: 39289311
DOI: 10.1007/s11739-024-03751-z

Abstract

To investigate the potential contribution of chest wall muscle area (CWMA) to the ventilatory efficiency and exercise capacity in patients with Systemic Sclerosis (SSc) without interstitial lung disease (ILD). Forty-four consecutive SSc patients [F = 37, median age 53.5 years (IQR 43.5-58)] were examined using chest high-resolution computed tomography (HRCT), pulmonary function tests and cardiopulmonary exercise testing (CPET). The CWMA was evaluated at the level of the ninth thoracic vertebra on CT images by two independent evaluators blinded to the patient information. CPET parameters analyzed were maximum oxygen uptake (VO2 max) and VO2 at anaerobic threshold (VO₂@AT); minute ventilation (VE); maximum tidal volume (VT). A statistically significant positive correlation was found between CWMA and maximum workload (r = 0.470, p < 0.01), VO2 max ml/min (r = 0.380, p < 0.01), VO2@AT (r = 0.343, p < 0.05), VE (r = 0.308, p < 0.05), VT (r = 0.410, p < 0.01) and VO2/heart rate (r = 0.399, p < 0.01). In multiple regression analysis, VO2 max (ml/min) was significantly associated with CWMA [β coefficient = 5.226 (95% CI 2.824, 7.628); p < 0.001], diffusing capacity for carbon monoxide (DLco) [β coefficient = 6.749 (95% CI 1.460, 12.039); p < 0.05] and body mass index (BMI) [β coefficient = 41.481 (95% CI 8.802, 74.161); p < 0.05]. In multiple regression analysis, maximum workload was significantly associated with CWMA [β coefficient = 0.490 (95% CI 0.289, 0.691); p < 0.001], DLco [β coefficient = 0.645 (95% CI 0.202, 1.088); p < 0.01] and BMI [β coefficient = 3.747 (95% CI 1.013, 6.842); p < 0.01]. In SSc-patients without ILD, CWMA represents an important variable in exercise capacity and can be evaluated by the mediastinal window available in the HRCT images required for lung disease staging.

Keywords: Cardiopulmonary exercise testing; Chest wall area; Interstitial lung disease; Low muscularity; Systemic sclerosis.