title: Right heart function and scleroderma: insights from tricuspid annular plane systolic excursion.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the use of echocardiographic parameters as predictors of rehospitalization in scleroderma patients.
  
  
  METHODS
  Echocardiographic studies were conducted in 38 patients with systolic scleroderma (SSc) to assess cardiopulmonary function. Forty-five age-matched volunteers without any sign of heart failure served as the control group. Transmitral flow pattern, tricuspid annular plane systolic excursion (TAPSE), left ventricular ejection fraction (LVEF), and right ventricular ejection fraction (RVEF) were evaluated. All patients were subsequently followed for one year.
  
  
  RESULTS
  Peak transmitral early-diastolic velocity (mitral E) and TAPSE measurements were significantly different between SSc and control patients (mitral E: 74.1 +/- 16.3 vs. 83.5 +/- 17.0 cm/s with P = 0.012; TAPSE: 2.4 +/- 0.43 vs. 1.9 +/- 0.39 cm with P < 0.0001). LVEF was similar, but RVEF was lower in the SSc group (LVEF: 61.7 +/- 9.7 vs. 61.7 +/- 5.8% with P = 0.962; RVEF: 49.6 +/- 6.8 vs. 39.2 +/- 6.7% with P < 0.0001). A strong correlation was found between TAPSE and RVEF. A TAPSE less than 1.96 cm indicted a RVEF less than 40% with a sensitivity of 81% and specificity of 78%. Contrary to expectation, pulmonary artery systolic pressure (PASP) did not correlate well with RV function (r = 0.261, r2= 0.068, P = 0.016). Finally, the frequency of rehospitalization was inversely correlated with RVEF and TAPSE in SSc patients.
  
  
  CONCLUSIONS
  We can predict the rehospitalization rate of SSc patients by TAPSE and RVEF, suggesting the involvement of heart, skin, lung, and other organs in scleroderma patients.
authors.affiliation: Cardiovascular Center, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C.
authors.forename: Chiu-Yen
authors.initials: CY
authors.lastname: Lee
authors.forename: Shu-Mei
authors.initials: SM
authors.lastname: Chang
authors.forename: Shih-Hung
authors.initials: SH
authors.lastname: Hsiao
authors.forename: Jui-Cheng
authors.initials: JC
authors.lastname: Tseng
authors.forename: Shih-Kai
authors.initials: SK
authors.lastname: Lin
authors.forename: Chun-Peng
authors.initials: CP
authors.lastname: Liu
mesh_terms: D000328:Adult; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011237:Predictive Value of Tests; D011379:Prognosis; D012595:Scleroderma, Systemic / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D013318:Stroke Volume; D013599:Systole; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging*; D016278:Ventricular Function, Right