Early impairment of myocardial function in systemic sclerosis: non-invasive assessment by Doppler myocardial and strain rate imaging.
BACKGROUND
Aim of the present study was to analyze both left (LV) and right ventricular (RV) myocardial function in patients with Systemic Sclerosis (SSc), and their relation to other instrumental features of the disease.


RESULTS
Twenty-five healthy subjects and 23 age- and sex-comparable asymptomatic patients classified as having either diffuse (11 patients) or limited form (12 patients) of SSc underwent clinical examination, serological tests, high-resolution chest-CT, standard Doppler echo, pulsed Doppler myocardial imaging (DMI) and strain rate imaging (SRI) of both LV and RV lateral walls. By chest-CT, 11 patients showed interstitial pulmonary fibrosis. Serological antibodies analysis detected anti-centromere pattern in 8 patients, and anti Scl-70 in 15 patients. LV diameters and ejection fraction were comparable between the two groups, while RV end-diastolic diameter was increased in SSc (p<0.01). Tricuspid inflow E/A ratio was slightly decreased in SSc (p<0.01), while systolic pulmonary pressure was increased (p<0.001). Pulsed DMI detected in SSc impaired myocardial RV early-diastolic (Em) peak velocity (p<0.0001), and prolonged myocardial time intervals at tricuspid annulus level. In SSc, peak systolic RV SR and strain were both reduced in basal, middle and apical RV lateral free walls, and in basal and middle LV lateral walls. By multivariate analysis, independent inverse association of RV peak Em velocity with both Rodnan Skin Score (p<0.0005) and pulmonary systolic pressure (p<0.0001), as well as independent inverse correlation of the same RV peak Em velocity with pulmonary fibrosis (<0.0005) in SSc patients were observed. In addition, RV Em was an independent predictor of the anti Scl-70 antibody pattern (p<0.001).


CONCLUSIONS
Pulsed DMI and SRI are valuable non-invasive and easy-repeatable tools for detecting RV and LV myocardial involvement caused by SSc, and may therefore be useful to early identify patients with more diffused and severe form of SSc.
D'Andrea
Antonello
A
Department of Interventional Cardiology, G. Rummo Hospital, Benevento, Italy. adandrea@synapsis.it
Stisi
Stefano
S
Bellissimo
Salvatore
S
Vigorito
Francesco
F
Scotto di Uccio
Fortunato
F
Tozzi
Nicola
N
Moscato
Francesco
F
Pezzullo
Enrica
E
Calabrò
Raffaele
R
Scherillo
Marino
M
D001323:Autoantibodies / Q000032:analysis / Q000276:immunology; D004264:DNA Topoisomerases, Type I; D003971:Diastole; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009687:Nuclear Proteins / Q000032:analysis / Q000276:immunology; D011658:Pulmonary Fibrosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D015203:Reproducibility of Results; D012595:Scleroderma, Systemic / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D012680:Sensitivity and Specificity; D013599:Systole
D001323:Autoantibodies; D009687:Nuclear Proteins; C048100:Scl 70 antigen, human; D004264:DNA Topoisomerases, Type I