Unique Abnormalities in Right Ventricular Longitudinal Strain in Systemic Sclerosis Patients.
Cardiac involvement in systemic sclerosis (scleroderma [SSc]) adversely affects long-term prognosis, often remaining undetectable despite close clinical examination and 2-dimensional echocardiographic monitoring. Speckle-derived strain of the right ventricle (RV) was utilized to detect occult abnormalities in regional and global contractility in SSc patients.



A total of 138 SSc patients with technically adequate echocardiograms was studied and compared with 40 age- and sex-matched healthy non-SSc controls. Standard assessment of RV chamber function included tricuspid annular plane systolic excursion and fractional area change. RV longitudinal systolic speckle-derived strain was assessed in the basal, mid, and apical free wall. Tricuspid annular plane systolic excursion was not different between groups (P=0.307). Although fractional area change was lower in SSc patients than in controls (mean, 48.9 versus 55; P=0.002), the mean fractional area change was still within the normal range (>35). In contrast, RV longitudinal systolic speckle-derived strain measures were significantly different between groups, both globally (-20.4% versus -17.7%; P=0.005) and regionally: they were decreased in the apex (-8.5% versus -17.1%; P<0.0001) and mid segments (-12.4% versus -20.9%; P<0.0001), and increased in the base (-32.2% versus -23.3%; P=0.0001) for the SSc group. The regional difference in the base compared with the apex was significantly greater for SSc than for controls (P<0.0001 for interaction). The differences observed in regional strain between SSc and control were unchanged after adjusting for RV systolic pressure.



Speckle-derived strain reveals a heterogenous pattern of regional heart strain in SSc that is not detected by conventional measures of function, suggestive of occult RV myocardial disease.
From the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (M.M., V.K.T., R.J.T., T.P.A.), Division of Pulmonary and Critical Care Medicine (S.-E.C.), and Division of Rheumatology (L.K.H., F.M.W., A.A.S.), Johns Hopkins University School of Medicine, Baltimore, MD. mmukher2@jhmi.edu.
Monica
M
Mukherjee
From the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (M.M., V.K.T., R.J.T., T.P.A.), Division of Pulmonary and Critical Care Medicine (S.-E.C.), and Division of Rheumatology (L.K.H., F.M.W., A.A.S.), Johns Hopkins University School of Medicine, Baltimore, MD.
Shang-En
SE
Chung
From the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (M.M., V.K.T., R.J.T., T.P.A.), Division of Pulmonary and Critical Care Medicine (S.-E.C.), and Division of Rheumatology (L.K.H., F.M.W., A.A.S.), Johns Hopkins University School of Medicine, Baltimore, MD.
Von Khue
VK
Ton
From the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (M.M., V.K.T., R.J.T., T.P.A.), Division of Pulmonary and Critical Care Medicine (S.-E.C.), and Division of Rheumatology (L.K.H., F.M.W., A.A.S.), Johns Hopkins University School of Medicine, Baltimore, MD.
Ryan J
RJ
Tedford
From the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (M.M., V.K.T., R.J.T., T.P.A.), Division of Pulmonary and Critical Care Medicine (S.-E.C.), and Division of Rheumatology (L.K.H., F.M.W., A.A.S.), Johns Hopkins University School of Medicine, Baltimore, MD.
Laura K
LK
Hummers
From the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (M.M., V.K.T., R.J.T., T.P.A.), Division of Pulmonary and Critical Care Medicine (S.-E.C.), and Division of Rheumatology (L.K.H., F.M.W., A.A.S.), Johns Hopkins University School of Medicine, Baltimore, MD.
Fredrick M
FM
Wigley
From the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (M.M., V.K.T., R.J.T., T.P.A.), Division of Pulmonary and Critical Care Medicine (S.-E.C.), and Division of Rheumatology (L.K.H., F.M.W., A.A.S.), Johns Hopkins University School of Medicine, Baltimore, MD.
Theodore P
TP
Abraham
From the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (M.M., V.K.T., R.J.T., T.P.A.), Division of Pulmonary and Critical Care Medicine (S.-E.C.), and Division of Rheumatology (L.K.H., F.M.W., A.A.S.), Johns Hopkins University School of Medicine, Baltimore, MD.
Ami A
AA
Shah
D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005355:Fibrosis; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009206:Myocardium / Q000473:pathology; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000150:complications* / Q000175:diagnosis; D013314:Stress, Mechanical; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016278:Ventricular Function, Right
cardiomyopathies; heart ventricles; hypertension, pulmonary; scleroderma, systemic; ventricular function, right