title: Contractile reserve in systemic sclerosis patients as a major predictor of global cardiac impairment and exercise tolerance.
abstract: Several studies have evidenced high prevalence of myocardial systolic and diastolic dysfunction among patients with systemic sclerosis (SSc). Exercise echocardiography has shown a diagnostic and prognostic role in identifying early left ventricular (LV) dysfunction in several myocardial pathological settings. The aim of our study was to evaluate early signs of LV impairment under exercise and their correlation to patient's exercise tolerance. Forty-five patients (age 60.4 ± 10.3 years) with SSc and 20 age and sex comparable controls were enrolled in the study. All patients underwent clinical evaluation, 2D echocardiography associated with Tissue Doppler and speckle tracking to evaluate LV deformation indexes, and an exercise echocardiography to evaluate left ventricle contractile reserve (LVCR) and exercise pulmonary pressures. Finally, a 6-minute walking test (6MWT) to evaluate exercise tolerance was also performed. Compared to controls, SSc patients showed an impaired diastolic function (E/E' 10.9 ± 3.7 vs 8.36 ± 2.01; p < 0.01) associated with larger left atrial dimensions (LAVI 28.4 ± 8.7 vs 19.3 ± 4.6 mL/m(2); p < 0.01). During exercise echocardiography, a reduced global longitudinal strain at peak exercise (S-GLS) was highlighted compared to controls (15.7 ± 3.6 vs 18.2 ± 2.2; p = 0.001). A S-GLS cutoff <18%, identified by ROC analysis, identified SSc patients with a reduced diastolic function, exercise tolerance at the 6MWT and higher pulmonary pressures. Our data show that in SSc patients a reduced LVCR characterizes the patients with a more extensive cardiovascular impairment in terms of LV diastolic function, pulmonary pressures and exercise tolerance. These data underline the importance of exercise echocardiography for the preclinical screening of the LV impairment in this population.
authors.affiliation: Department of Medical Sciences "M. Aresu", University of Cagliari, Strada Statale 554, Km 4.500, 09042, Monserrato, Cagliari, Italy, cadedduc@tiscali.it.
authors.forename: Christian
authors.initials: C
authors.lastname: Cadeddu
authors.forename: Martino
authors.initials: M
authors.lastname: Deidda
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Giau
authors.forename: Marzia
authors.initials: M
authors.lastname: Lilliu
authors.forename: Fabio
authors.initials: F
authors.lastname: Cadeddu
authors.forename: Giulio
authors.initials: G
authors.lastname: Binaghi
authors.forename: Mario Nicola
authors.initials: MN
authors.lastname: Mura
authors.forename: Michela
authors.initials: M
authors.lastname: Farci
authors.forename: Stefano
authors.initials: S
authors.lastname: Del Giacco
authors.forename: Paolo Emilio
authors.initials: PE
authors.lastname: Manconi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mercuro
mesh_terms: D000368:Aged; D019540:Area Under Curve; D062186:Arterial Pressure; D016022:Case-Control Studies; D018618:Echocardiography, Doppler, Color; D025401:Echocardiography, Stress; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000503:physiopathology; D012372:ROC Curve; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000150:complications* / Q000175:diagnosis; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left; D016138:Walking