title: Tissue Doppler imaging in systemic sclerosis: a 3-year longitudinal study.
abstract: OBJECTIVE
  To investigate by standard echocardiography and pulsed-tissue Doppler imaging (TDI) the course of systemic sclerosis (SSc) heart disease and its correlation with epidemiological, clinical, and serological features of the disease and drug treatment.
  
  
  METHODS
  A total of 74 consecutive patients (69 females, between the ages of 19 and 71 years, and disease duration 1-43 years) and 71 controls underwent cardiac assessment at baseline and at 3-year follow-up.
  
  
  RESULTS
  At baseline, compared to controls, patients showed post-Bonferroni correction, impaired left (LV) and right ventricular (RV) diastolic function (Em/Am 0.85 ± 0.4 vs 1.5 ± 0.7, p = 0.0003; Et/At 0.9 ± 0.3 vs 1.3 ± 0.4, p = 0.0003), subtle LV and RV systolic dysfunction (Sm 13.7 ± 2.7 vs 15.4 ± 3.2cm/s, p = 0.031; St < 11.5cm/s in 16/74 patients vs 0 controls, p = 0.0031), and higher pulmonary artery systolic pressure (sPAP) (26.1 ± 6.0 vs 24.1 ± 5.1, p = 0.040). At 3-year follow-up, SSc patients showed a further deterioration of biventricular diastolic and systolic function and a further sPAP increase. At multiple regression analysis of baseline data, Em/Am < 1 was detected in 55/74 patients vs 25/71 controls (p < 0.0001) and was associated with age (p = 0.030); Et/At < 1 was detected in 16/74 patients vs 7/71 controls (p < 0.0001), was associated with NYHA class ≥ II (p = 0.033), late capillaroscopic pattern (p = 0.029), and a baseline cardiac Medsger severity score ≥ 1 (p = 0.029). TDI evidence of new abnormalities in RV and/or LV diastolic function was associated with a baseline cardiac Medsger severity score ≥ 1 (p = 0.01). Neither diastolic or systolic abnormalities nor sPAP changes correlated with treatment.
  
  
  CONCLUSIONS
  Our study confirms that SSc patients exhibit biventricular systolic and diastolic dysfunction and increased sPAP and reveals further deterioration at 3-year follow-up.
authors.affiliation: Department of Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: D'Alto
authors.affiliation: Rheumatology Unit, Second University of Naples, II Policlinico, Via Pansini 5, Naples 80131, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Cuomo
authors.affiliation: Department of Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Romeo
authors.affiliation: Department of Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Argiento
authors.affiliation: Rheumatology Unit, Second University of Naples, II Policlinico, Via Pansini 5, Naples 80131, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Iudici
authors.affiliation: Rheumatology Unit, Second University of Naples, II Policlinico, Via Pansini 5, Naples 80131, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Vettori
authors.affiliation: Department of Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Giovanna Russo
authors.affiliation: Department of Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Calabrò
authors.affiliation: Rheumatology Unit, Second University of Naples, II Policlinico, Via Pansini 5, Naples 80131, Italy. Electronic address: gabriele.valentini@unina2.it.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Valentini
mesh_terms: D000328:Adult; D000368:Aged; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012595:Scleroderma, Systemic / Q000150:complications / Q000000981:diagnostic imaging*; D018754:Ventricular Dysfunction / Q000150:complications / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: Pulmonary artery systolic pressure; Systemic sclerosis; Tissue Doppler imaging; Ventricular function