title: Myocardial contractility is early affected in systemic sclerosis: a tissue Doppler echocardiography study.
abstract: 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.
authors.affiliation: 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
authors.forename: Christophe
authors.initials: C
authors.lastname: Meune
authors.forename: Yannick
authors.initials: Y
authors.lastname: Allanore
authors.forename: Olivier
authors.initials: O
authors.lastname: Pascal
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Devaux
authors.forename: Odile
authors.initials: O
authors.lastname: Dessault
authors.forename: Denis
authors.initials: D
authors.lastname: Duboc
authors.forename: Simon
authors.initials: S
authors.lastname: Weber
authors.forename: André
authors.initials: A
authors.lastname: Kahan
mesh_terms: 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