Myocardial contractility is early affected in systemic sclerosis: a tissue Doppler echocardiography study.
OBJECTIVE
Systemic sclerosis (SSc) is a connective tissue disorder characterized by frequent myocardial involvement. Alteration in left ventricular (LV) function is reported to be rare; however, it may be underestimated by conventional measurements. Our aim was to prospectively investigate LV function in SSc patients, using Tissue Doppler echocardiography (TDE), a modern and accurate method of assessing myocardial function.


RESULTS
Seventeen consecutive SSc patients with normal cardiac examination, pulmonary artery pressure (PAP) and radionuclide LV ejection fraction (EF) were prospectively investigated. Myocardial perfusion was investigated using single-photon-emission computerized tomography (SPECT). Echocardiography (ECHO), systolic and diastolic strain-rate (SR) measured in the posterior wall by TDE were used to investigate myocardial function, and compared with results of 15 matched controls. All patients (53+/-8 years; 14 women; systolic PAP 33+/-6 mmHg; LVEF 67+/-8%) had myocardial SPECT perfusion abnormalities. Despite normal ECHO, they had lower systolic SR than controls (1.7+/-0.5 versus 3.8+/-1.7 cm-1, p<0.0001), and lower diastolic SR (3.7+/-1.5 versus 5.6+/-1.2 cm-1, p=0.0004). Ten SSc patients had reduced systolic SR<1.7 cm-1 and 11 reduced diastolic SR<3.5 cm-1.


CONCLUSIONS
Frequent abnormal myocardial perfusion is confirmed in SSc patients. Reduced contractility is also frequent as detected by TDE, despite normal radionuclide LVEF.
Meune
Christophe
C
Department of Cardiology, Cochin Hospital, AP-HP, René Descartes University, 27 rue du Fg St-Jacques, 75014 Paris, France. christophe.meune@cch.ap-hop-paris.fr
Allanore
Yannick
Y
Pascal
Olivier
O
Devaux
Jean-Yves
JY
Dessault
Odile
O
Duboc
Denis
D
Weber
Simon
S
Kahan
André
A
D001783:Blood Flow Velocity; D002037:Bundle-Branch Block / Q000503:physiopathology; D009202:Cardiomyopathies / Q000503:physiopathology; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D015425:Myocardial Reperfusion; D009206:Myocardium / Q000473:pathology*; D015588:Observer Variation; D011446:Prospective Studies; D015635:Radionuclide Ventriculography; D012107:Research Design; D012595:Scleroderma, Systemic / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D013318:Stroke Volume; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D014797:Vital Capacity