title: Echocardiographic alterations in systemic sclerosis: a longitudinal study.
abstract: OBJECTIVE
  To investigate the evolution of cardiac alterations in systemic sclerosis (SSc).
  
  
  METHODS
  Echocardiographic and echo-Doppler findings from 77 unselected SSc patients were analyzed at the first clinical observation and after a follow-up period of 65 +/- 36 months. Data were compared with those obtained from 45 normal subjects matched for age and sex.
  
  
  RESULTS
  Baseline left ventricular (LV) systolic function was normal in all patients and controls while LV diastolic dysfunction (expressed by an inverted E/A ratio which represents early and late filling of the LV during atrial contraction) was present in 23 patients and in 1 control ( P < 0.001). At the end of the follow-up period, while LV systolic function declined in 1 case alone, 6 further patients developed an inverted E/A ratio. Moreover, in the group of SSc patients mean A-wave values, E/A ratio, left atrial dimension, and LV wall thickness significantly changed, all indicating the progression of heart involvement. The alteration of LV diastolic function was independent of other known causes potentially affecting LV relaxation. Moreover, impairment of LV filling parameters was detected in the first phase of follow-up, while the anatomical changes occurred in the last phase.
  
  
  CONCLUSIONS
  Our data confirm the significant prevalence of LV diastolic dysfunction in SSc patients and the role of primary myocardial involvement. The long-term follow-up demonstrates that LV filling dysfunction is progressive and precedes the occurrence of LV remodeling.
authors.affiliation: Department of Clinical Medicine, Cardiovascular and Immunological Science, University of Naples Federico II, Italy. smaione@unina.it
authors.forename: Stefania
authors.initials: S
authors.lastname: Maione
authors.forename: Giovanna
authors.initials: G
authors.lastname: Cuomo
authors.forename: Anna
authors.initials: A
authors.lastname: Giunta
authors.forename: Laura
authors.initials: L
authors.lastname: Tanturri de Horatio
authors.forename: Giovanni
authors.initials: G
authors.lastname: La Montagna
authors.forename: Francesco
authors.initials: F
authors.lastname: Manguso
authors.forename: Ivo
authors.initials: I
authors.lastname: Alagia
authors.forename: Gabriele
authors.initials: G
authors.lastname: Valentini
mesh_terms: D000328:Adult; D017677:Age Distribution; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology; D016022:Case-Control Studies; D016001:Confidence Intervals; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011336:Probability; D011379:Prognosis; D012016:Reference Values; D012595:Scleroderma, Systemic / Q000175:diagnosis* / Q000401:mortality; D012720:Severity of Illness Index; D017678:Sex Distribution; D013318:Stroke Volume / Q000502:physiology*; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality