title: The relationship between left ventricular deformation and heart rate variability in patients with systemic sclerosis: Two- and three-dimensional strain analysis.
abstract: OBJECTIVE
  We sought to investigate left ventricular (LV) function and deformation, as well as heart rate variability (HRV), and their relationship, in patients with systemic sclerosis (SSc).
  
  
  METHODS
  The study included 49 SSc patients and 38 age-matched healthy subjects. All patients underwent clinical examination, serological tests, 24-h Holter monitoring, and comprehensive two- and three-dimensional echocardiography (2DE and 3DE).
  
  
  RESULTS
  2DE and 3DE LV global longitudinal and circumferential strain, as well as 3DE area strains are significantly reduced in SSc patients comparing with controls. 2DE and 3DE LV radial strains are similar between the observed groups. 2DE LV layer-specific longitudinal and circumferential strains are also significantly affected by SSc. Parameters of cardiac autonomic nervous system, assessed by HRV indices, SDNN, SDANN, rMMSD, p50NN, 24-h HF, LF and TP are significantly lower in SSc group. HRV indices (24-h HF and LF) are associated with 2DE LV global, 2DE LV layer-specific and 3DE LV mechanics independently of main demographic, clinical and echocardiographic parameters of the study population. Additionally, Modified Rodnan Skin Score, clinical parameter of skin involvement in SSc, is significantly associated with HRV (24-h HF and LF), 2DE and 3DE LV deformation.
  
  
  CONCLUSIONS
  SSc significantly impacts LV deformation, all myocardial layers, and cardiac autonomic nervous function. A significant association between cardiac autonomic nervous system function, skin involvement and LV mechanics is revealed in SSc patients. These findings should encourage detailed cardiac assessment and further cardiac follow-up of the SSc patients with higher skin involvement, even when traditional echocardiographic parameters are within normal range.
authors.affiliation: University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Cardiology Department, Heroja Milana Tepica 1, 11000 Belgrade, Serbia. Electronic address: marijana_tadic@hotmail.com.
authors.forename: Marijana
authors.initials: M
authors.lastname: Tadic
authors.affiliation: Institute of Rheumatology, Resavska 69, 11000 Belgrade, Serbia.
authors.forename: Maja
authors.initials: M
authors.lastname: Zlatanovic
authors.affiliation: University of Milan-Bicocca and Istituto Auxologico Italiano, Clinical Research Unit, Viale della Resistenza 23, 20036 Meda, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Cuspidi
authors.affiliation: Clinical Centre of Serbia, Clinic of Cardiology, Koste Todorovic 8, 11000 Belgrade, Serbia.
authors.forename: Branislava
authors.initials: B
authors.lastname: Ivanovic
authors.affiliation: University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Cardiology Department, Heroja Milana Tepica 1, 11000 Belgrade, Serbia.
authors.forename: Ana
authors.initials: A
authors.lastname: Stevanovic
authors.affiliation: Institute of Rheumatology, Resavska 69, 11000 Belgrade, Serbia.
authors.forename: Nemanja
authors.initials: N
authors.lastname: Damjanov
authors.affiliation: University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Cardiology Department, Heroja Milana Tepica 1, 11000 Belgrade, Serbia.
authors.forename: Vesna
authors.initials: V
authors.lastname: Kocijancic
authors.affiliation: University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Cardiology Department, Heroja Milana Tepica 1, 11000 Belgrade, Serbia.
authors.forename: Vera
authors.initials: V
authors.lastname: Celic
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004452:Echocardiography; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012595:Scleroderma, Systemic / Q000000981:diagnostic imaging* / Q000503:physiopathology; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Heart rate variability; Left ventricle; Strain; Systemic sclerosis