![[Visit Client Website]](images/banner.gif)
Presentation Number: 1883
Introduction
Primary myocardial involvement due to microcirculation impairment is common in systemic sclerosis (SSc). When sensitive tools are used it has been estimated to occur in up to 100% of patients. Once cardiac involvement is clinically evident, it is recognized as a poor prognostic factor. Altered left ventricular ejection fraction (LVEF) is rarely reported but may be underestimated due to the lack of sensitivity of conventional methods; indeed, we previously demonstrated the accuracy and validated assessment of myocardial dysfunction by Tissue- Doppler echocardiography (TDE) in a selected subgroup of patients (Meune et al, Eur J Echocardiogr 2005;6:351-7).
The aim of our study was to determine the prevalence of myocardial dysfunction using conventional echocardiography as well as TDE in the routine assessment of patients with SSc.
Patients and Methods
In order to evaluate primary heart involvement, the diagnosis of pulmonary arterial hypertension based on right heart catheterism was an exclusion criterion (n=5 during the time period of the study) together with clinical symptoms of heart failure (n=2). We included 66 consecutive SSc patients; mean±SD age was 54±12 years and disease duration was 7±7 years, 36 patients had a diffuse cutaneous subtype, 36 patients had a pulmonary fibrosis on CT-scan, 24 patients had reduced forced vital capacity, 33 patients had decreased lung carbon monoxide diffusion capacity.
All patients underwent conventional echocardiography and TDE at rest. Normal values in our laboratory and according to published literature are: for LV systolic function, LVEF >55% (measured by conventional echocardiography) and mitral annular systolic velocity >7.5 cm.s-1 (TDE); for LV diastolic function, transmitral Doppler E/A ratio>1 (conventional echocardiography); for RV systolic function, tricuspid systolic lateral annular velocity >11.5 cm.s-1 (TDE).
Results
Two patients only had reduced LVEF assessed by conventional echocardiography; in contrast 10/66 had reduced LV systolic function as assessed by TDE. Abnormal RV systolic function was demonstrated by TDE in 10/66 patients (4 having both reduced LV and RV systolic function). 34/66 had diastolic LV dysfunction. No characteristic of the disease was found to be associated with reduced contractility.
Conclusion
Our study using conventional echocardiography and TDE on a routine basis demonstrate a high prevalence of reduced contractility in patients with SSc. Our study hence confirms the greater superiority of TDE versus conventional methods for contractility assessment. Both left and right ventricles seem to be targeted by the disease. Predictive value of TDE measurements are under evaluation.
Primary myocardial involvement due to microcirculation impairment is common in systemic sclerosis (SSc). When sensitive tools are used it has been estimated to occur in up to 100% of patients. Once cardiac involvement is clinically evident, it is recognized as a poor prognostic factor. Altered left ventricular ejection fraction (LVEF) is rarely reported but may be underestimated due to the lack of sensitivity of conventional methods; indeed, we previously demonstrated the accuracy and validated assessment of myocardial dysfunction by Tissue- Doppler echocardiography (TDE) in a selected subgroup of patients (Meune et al, Eur J Echocardiogr 2005;6:351-7).
The aim of our study was to determine the prevalence of myocardial dysfunction using conventional echocardiography as well as TDE in the routine assessment of patients with SSc.
Patients and Methods
In order to evaluate primary heart involvement, the diagnosis of pulmonary arterial hypertension based on right heart catheterism was an exclusion criterion (n=5 during the time period of the study) together with clinical symptoms of heart failure (n=2). We included 66 consecutive SSc patients; mean±SD age was 54±12 years and disease duration was 7±7 years, 36 patients had a diffuse cutaneous subtype, 36 patients had a pulmonary fibrosis on CT-scan, 24 patients had reduced forced vital capacity, 33 patients had decreased lung carbon monoxide diffusion capacity.
All patients underwent conventional echocardiography and TDE at rest. Normal values in our laboratory and according to published literature are: for LV systolic function, LVEF >55% (measured by conventional echocardiography) and mitral annular systolic velocity >7.5 cm.s-1 (TDE); for LV diastolic function, transmitral Doppler E/A ratio>1 (conventional echocardiography); for RV systolic function, tricuspid systolic lateral annular velocity >11.5 cm.s-1 (TDE).
Results
Two patients only had reduced LVEF assessed by conventional echocardiography; in contrast 10/66 had reduced LV systolic function as assessed by TDE. Abnormal RV systolic function was demonstrated by TDE in 10/66 patients (4 having both reduced LV and RV systolic function). 34/66 had diastolic LV dysfunction. No characteristic of the disease was found to be associated with reduced contractility.
Conclusion
Our study using conventional echocardiography and TDE on a routine basis demonstrate a high prevalence of reduced contractility in patients with SSc. Our study hence confirms the greater superiority of TDE versus conventional methods for contractility assessment. Both left and right ventricles seem to be targeted by the disease. Predictive value of TDE measurements are under evaluation.
Y. Allanore, None.