High prevalence of right ventricular systolic dysfunction in early systemic sclerosis.
OBJECTIVE
To assess right ventricular (RV) function in patients with early systemic sclerosis (SSc) and the acute effects of calcium channel blockers on RV ejection fraction (RVEF).


METHODS
Forty-two consecutive patients with SSc with less than 5 years' disease duration and normal pulmonary arterial pressure (35 women, 7 men; mean age 54.3 +/- 9.7 years; 16 with diffuse and 26 with limited cutaneous forms, systolic pulmonary arterial pressure 30.3 +/- 5.4 mmHg) were prospectively evaluated. All underwent pulmonary function testing, echocardiography, and radionuclide ventriculography at rest and 2 hours after receiving 40 mg oral nicardipine, and were compared at baseline with 20 gender and age matched controls.


RESULTS
None of the patients with SSc had clinical evidence of heart failure. At baseline, SSc patients had significantly lower LVEF (68.5% +/- 7.9 vs 72.4% +/- 5.0, p = 0.049) and RVEF (36.5% +/- 7.0 vs 45.8% +/- 5.7, p < 0.0001). Sixteen patients had reduced RVEF (< 35%), 3 had reduced LVEF (< 55%), and 10 had reduced peak filling rate (PFR). RVEF correlated to both LVEF and PFR (r = 0.64, p < 0.0001, and r = 0.36, p = 0.0037, respectively), whereas no correlation was found with pulmonary function impairment or pulmonary arterial pressure. Nicardipine resulted in a significant increase in RVEF (from 36.5% +/- 7.0 to 42.3% +/- 8.4, p < 0.001) whereas afterload indicated by mean arterial pressure did not differ significantly.


CONCLUSIONS
Reduced RVEF appears to be a common feature in early SSc; it may be due to intrinsic myocardial involvement and is acutely improved by nicardipine.
Department of Cardiology, Cochin Hospital, APHP, Paris V University, Paris, France.
Christophe
C
Meune
Yannick
Y
Allanore
Jean-Yves
JY
Devaux
Odile
O
Dessault
Denis
D
Duboc
Simon
S
Weber
André
A
Kahan
D000328:Adult; D000368:Aged; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009529:Nicardipine / Q000627:therapeutic use; D015635:Radionuclide Ventriculography; D012595:Scleroderma, Systemic / Q000150:complications* / Q000503:physiopathology; D013223:Statistics as Topic; D013599:Systole; D018497:Ventricular Dysfunction, Right / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control*; D016277:Ventricular Function, Left / Q000502:physiology
D002121:Calcium Channel Blockers; D009529:Nicardipine