A right ventricular diastolic impairment is common in systemic sclerosis and is associated with other target-organ damage.
OBJECTIVE
Heart involvement in systemic sclerosis (SSc) is a strong prognostic factor. Our aim was to examine left ventricle (LV) and right ventricle (RV) involvement.


METHODS
We examined LV and RV, systolic and diastolic functions, using echocardiography and Tissue-Doppler echocardiography (TDE) indexes, in a cohort of 212 consecutive SSc patients seen during a 9-month period at 2 institutions (Paris, France and Los Angeles, USA). They were compared to 50 healthy controls.


RESULTS
When compared to controls, SSc patients had consistently impaired RV indices that include reduced RV contractility (p < 0.001), larger right atrial area (p = 0.027) and overall RV diastolic dysfunction (25% of SSc patients versus 0% of controls; p < 0.001). Patients also exhibited alterations in LV contractility and diastolic function (p < 0.001 each). In multivariate analysis, RV contractility as expressed by the TDE S(T) parameter was associated with TDE LV contractility S(M) (p = 0.030), DLCO (p = 0.013) whereas RV diastolic impairment was associated with systolic pulmonary artery pressure (p = 0.015). A subgroup of 27 patients had proven pulmonary arterial hypertension (PAH); comparison between SSc-PAH versus SSc free of PAH patients revealed reduced LV diastolic function (transmitral E/A ratio, p = 0.045 and E(A) < 10 cm/s, p = 0.029), reduced overall RV contractility (21.5% versus 4.5%; p = 0.03) and reduced RV diastolic function (transtricuspid E/A ratio; p = 0.014 and 68% versus 29% with impaired function; p = 0.001).


CONCLUSIONS
Our data show that RV is commonly affected in SSc with predominant impaired diastolic function. Several factors, including primary heart, lung vascular disease and pulmonary hypertension, contribute to such impairment.
Department of Cardiology, Paris 13 University, Avicenne Hospital, AP-HP, 125 rue de Stalingrad, Bobigny 93000, France; UMR S 942, Lariboisière Hospital, Paris, France; Department of Cardiology, Paris-Descartes University, Cochin Hospital, AP-HP, Paris, France. Electronic address: christophe.meune@avc.aphp.fr.
Christophe
C
Meune
University of Michigan Scleroderma Program, Ann Arbor, MI.
Dinesh
D
Khanna
Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Jamil
J
Aboulhosn
Department of Rheumatology A, Paris-Descartes University, Cochin Hospital, AP-HP, Paris, France. Electronic address: javouac@me.com.
Jérôme
J
Avouac
Department of Rheumatology A, Paris-Descartes University, Cochin Hospital, AP-HP, Paris, France.
André
A
Kahan
Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Daniel E
DE
Furst
Department of Rheumatology A, Paris-Descartes University, Cochin Hospital, AP-HP, Paris, France.
Yannick
Y
Allanore
D000328:Adult; D000368:Aged; D003971:Diastole / Q000502:physiology*; D015150:Echocardiography, Doppler; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012595:Scleroderma, Systemic / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology
Cardiovascular; Diastolic dysfunction; Echocardiography; Myocardial involvement; Right ventricle; Systemic sclerosis