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Patients with systemic sclerosis (SSc) are at risk for developing pulmonary hypertension (PH) which is a major cause of death in this population. Echocardiographic (TTE) derived pulmonary arterial pressure (PAP) can be unreliable for the early detection of PH. Previous studies demonstrate that the ECG derived ventricular gradient optimized for right ventricular pressure overload (VG-RVPO) can detect PH in a heterogeneous population suspected of PH. The aim of this study is to assess the use of the VG-RVPO as a screening and monitoring instrument of early PH in SSc patients.Serial ECGs and TTEs from twenty-seven SSc patients who underwent right heart catheterization (RHC) were retrospectively analyzed. The changes in PAP and VG-RVPO over time were studied in patients with and without diagnosed PH.Twenty-four patients (52.5% female, mean age 58.4 years SD 14.3) were studied. In eleven patients PH was confirmed with RHC. In these patients VG-RVPO was significantly higher -8 ± 19 than in patients without PH -23 ± 10 mV·ms, (P 0.05). In addition, in PH patients the VG-RVPO increased over time in contrast to patients without PH (P 0.01). The VG was more sensitive to detect disease progression in earlier stages of disease as compared to echocardiographic derived PAP.The VG-RVPO is a sensitive, non-invasive and cost effective tool for early detection of PH in SSc patients. Serial measurements indicate that the VG-RVPO can be used as a follow-up instrument and outperforms TTE to detect early changes in right ventricular pressure over time.

Background Cardiac events are an important cause of mortality in Systemic Sclerosis (SSc), but its diagnosis remains challenging. Left ventricular global longitudinal strain is a novel parameter derived from speckle tracking echocardiographic analysis which has been proposed to identify patient at higher risk of cardiac events. Objectives We aimed to identify clinical and echocardiographic (including GLS) parameters associated with all-cause mortality and cardiovascular events in SSc patients. Methods 408 SSc patients (344 females, age 54±14 years.) were prospectively evaluated at baseline and follow-up (FU time 3.3 years. [IQR 1.8 to 5.5]). Cardiovascular events included: heart failure, cardiac infarction, coronary interventions, device implantation, arrhythmias, cerebral infarction, peripheral ischaemic vascular disease. Results All-cause mortality (n=37) or cardiovascular events (n=57) occurred in 84 patients. At baseline, these patients were older (59±14 vs. 53±14 years., p 200 ng/L), survival rates were lower and cardiovascular events increased when GLS was impaired and worsened when NT-proBNP was elevated (Log-rank p Conclusions In SSc patients, next to age, DLCO and NT-proBNP, GLS strongly associates with all-cause mortality and cardiovascular events, indicating that these parameters reflect relevant cardiac involvement in SSc, and as such can contribute to risk stratification and patient management. Disclosure of Interest None declared

Background Cardiac involvement is a main cause of mortality in systemic sclerosis (SSc) 1 . Its detection remains challenging using conventional echocardiographic parameters and little is known about which patients are at risk for deterioration of cardiac function. Speckle-tracking strain analysis of echocardiographic images can detect subtle myocardial dysfunction in patients with SSc, and decreased strain has been shown to associate with lower functional capacity and rhythm disturbances 2 Objectives This study evaluated: 1. changes in cardiac performance over time in SSc patients including echocardiographic myocardial speckle tracking strain analysis, and 2. baseline characteristics associated with deterioration of cardiac function. Methods 205 SSc patients (171 female, 52±14 years) were evaluated at baseline and follow-up (2.25years IQR1.3–3.8), including complete physical examination and screening for organ involvement with at least HRCT-thorax, pulmonary function test, cardiopulmonary exercise test, electrocardiography and echocardiography. Results Left ventricular (LV) ejection fraction did not change significantly (61%±7 vs 61%±8,p=0.148) while global longitudinal strain (LS) decreased significantly (-21%±2 vs -19%±3, p Conclusions In SSc patients, progression of LV systolic dysfunction was detected by speckle tracking strain analysis but not by LV ejection fraction. Proximal muscle weakness, DLCO and LV diastolic function may identify patients at higher risk and in need of closer cardiac monitoring. References Rubio-Rivas M, Royo C et al. Mortality and survival in systemic sclerosis: systematic review and meta-analysis. Semin Arthritis Rheum 2014 Oct;44(2):208–19. Yiu KH, Schouffoer AA, et al. Left ventricular dysfunction assessed by speckle-tracking strain analysis in patients with systemic sclerosis: relationship to functional capacity and ventricular arrhythmias. Arthritis Rheum 2011 Dec;63(12):3969–78. Disclosure of Interest None declared

BACKGROUND: Anti-IgE, omalizumab, inhibits the allergen response in patients with asthma. This has not been directly related to changes in inflammatory conditions. We hypothesized that anti-IgE exerts its effects by reducing airway inflammation. To that end, the effect of anti-IgE on allergen-induced inflammation in bronchial biopsies in 25 patients with asthma was investigated in a randomized, double-blind, placebo-controlled study. METHODS: Allergen challenge followed by a bronchoscopy at 24 h was performed at baseline and after 12 weeks of treatment with anti-IgE or placebo. Provocative concentration that causes a 20% fall in forced expiratory volume in 1 s (PC(20)) methacholine and induced sputum was performed at baseline, 8 and 12 weeks of treatment. Changes in the early and late responses to allergen, PC(20), inflammatory cells in biopsies and sputum were assessed. RESULTS: Both the early and late asthmatic responses were suppressed to 15.3% and 4.7% following anti-IgE treatment as compared with placebo (P < 0.002). This was paralleled by a decrease in eosinophil counts in sputum (4-0.5%) and postallergen biopsies (15-2 cells/0.1 mm(2)) (P < 0.03). Furthermore, biopsy IgE+ cells were significantly reduced between both the groups, whereas high-affinity IgE receptor and CD4+ cells were decreased within the anti-IgE group. There were no significant differences for PC(20) methacholine. CONCLUSION: The response to inhaled allergen in asthma is diminished by anti-IgE, which in bronchial mucosa is paralleled by a reduction in eosinophils and a decline in IgE-bearing cells postallergen without changing PC(20) methacholine. This suggests that the benefits of anti-IgE in asthma may be explained by a decrease in eosinophilic inflammation and IgE-bearing cells