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FRI0210 Cardiac involvement in systemic sclerosis (ssc) – doppler echorardiography studies in 100 ssc patients
  1. AV Volkov,
  2. GP Kotelnikova,
  3. ES Match
  1. Department of Microcirculation and Inflammation, Institute of Rheumatology of RAMS, Moscow, Russia

Abstract

Background Cardiac involvement is a relatively common occurrence in systemic sclerosis. When this complication is clinically recognisable, the prognosis is usually poor. However, heart abnormalities is frequently asymptomatic and they can only be diagnosed by Doppler- echocardiography.

Objectives The aim of this study is to find out the frequency of different variants of cardiac involvements in SSc pts and connexion with other SSc manifestation.

Methods 100 SSc pts (18 male and 82 women, mean age ± SD 51,8 ± 14,1 years, ranging from 15 to 83 years, mean duration of disease ± SD 10,11 ± 9,22 years). All of the pts were clinically studied with Doppler Ehocardiography.

Results According to the Doppler Ehocardiography studies cardiac involvement was found in 82% occurences, and was the most frequent symptoms of internal organ damage. Pericard, myocard and endocard were involved. Pericarditis was found in 30% pts, higher frequency (25%) in limited cutaneous SSc, and correlated with disease duration. Pericardit pts have more frequently interstitial lung disease, pulmonary hypertension. The microcirculation changies such as tendency to decreasing of basal digital blood flow and the reduction of capillar loops density were noted in the pericardit patients. The changes in the size of left ventricular were more frequent in pts with diffuse cutaneous SSc, shorter duration of the disease and artherial hypertension, the latter does not exclude the influence of age factors in evolution of these changes. Diastolic disfunction was found in 25% and most frequently in the elderly pts with arterial hypertension. However, the fact of the correlation between diastolic disfunction and high level of ESR (r = 0,364, p < 0,05) as well as fibrinogen concentration (r = 0,325, p < 0,05) and reduction of capillary loops do not exclude the influence of sclerodermic fibrosis on these abnormalities. Mitral (22%) and aortal (5%) regurgitations were the most frequent indication of endocard damage, however, there was no significant difference between these abnormalities and other clinical manifestations of SSc. Fifty one out of 100 pts (51%) were diagnosed as having pulmonary hypertension (PH), including 15 pts having isolated PH without other antecedent pulmonary or cardiac conditions. Correlations were found between PH and age of pts, high level of ESR and fibrinogen concentration. Twenty-six pts out of 100 did not complain on cardiac problem, but Doppler Ehocardiography studies showed pericarditis in two cases, diastolic abnormality in three cases, mitral regurgitation in four cases and pulmonary hypertension also in four cases.

Conclusion Doppler Ehocardiography is an important method in diagnosis of cardial involvement in SSc pts including those without any symptoms of sclerodermic cardiac disease.

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