Early impairment of myocardial function in systemic sclerosis: Non-invasive assessment by Doppler myocardial and strain rate imaging

Abstract: Background: Aim of the present study was to analyze both left (LV) and right ventricular (RV) myocardial function in patients with Systemic Sclerosis (SSc), and their relation to other instrumental features of the disease. Methods and results: Twenty-five healthy subjects and 23 age- and sex-comparable asymptomatic patients classified as having either diffuse (11 patients) or limited form (12 patients) of SSc underwent clinical examination, serological tests, high-resolution chest-CT, standard Doppler echo, pulsed Doppler myocardial imaging (DMI) and strain rate imaging (SRI) of both LV and RV lateral walls. By chest-CT, 11 patients showed interstitial pulmonary fibrosis. Serological antibodies analysis detected anti-centromere pattern in 8 patients, and anti Scl-70 in 15 patients. LV diameters and ejection fraction were comparable between the two groups, while RV end-diastolic diameter was increased in SSc (p <0.01). Tricuspid inflow E/A ratio was slightly decreased in SSc (p <0.01), while systolic pulmonary pressure was increased (p <0.001). Pulsed DMI detected in SSc impaired myocardial RV early-diastolic (E _m) peak velocity (p <0.0001), and prolonged myocardial time intervals at tricuspid annulus level. In SSc, peak systolic RV SR and strain were both reduced in basal, middle and apical RV lateral free walls, and in basal and middle LV lateral walls. By multivariate analysis, independent inverse association of RV peak E _m velocity with both Rodnan Skin Score (p <0.0005) and pulmonary systolic pressure (p <0.0001), as well as independent inverse correlation of the same RV peak E _m velocity with pulmonary fibrosis (<0.0005) in SSc patients were observed. In addition, RV E _m was an independent predictor of the anti Scl-70 antibody pattern (p <0.001). Conclusions: Pulsed DMI and SRI are valuable non-invasive and easy-repeatable tools for detecting RV and LV myocardial involvement caused by SSc, and may therefore be useful to early identify patients with more diffused and severe form of SSc. [Copyright &y& Elsevier]