Background Cardiac involvement and clinically silent cardiac changes are reported rarely in patients with primary Sjogren’s Syndrome (pSS) whereas: a. increased rate of pericarditis (usually silent with echocardiographic findings) and mitral valve regurgitation, b. myocardiac involvement (autoimmune – asymptomatic myocarditis), and c. left ventricular diastolic dysfunction have been presented in case reports and controlled studies.
Objectives The echocardiographic evaluation of the anatomic and functional heart disorders in patients with pSS (without risk factors for coronary heart disease or other symptoms of heart disease), the comparison of these findings with that of the control group, and the correlation with clinical and laboratory data (ANA, anti-Ro (SSA), anti-La (SSB), anti-CL, anti-b2GPI, RF).
Methods Pulsed, colour Doppler echocardiography was performed in seventy eight (78) patients (pts) with pSS (european criteria) (75 women and 3 men), mean age 51 ± 11.6(years) and mean disease duration 7.7 ± 4.26(years) and 80 healthy controls (78 women and 2 men) mean age 51 ± 9.5(years). Left-ventricular (LV) dimensions and interventricular septum and posterior wall thickness at end-diastole were measured for the calculation of the fractional shortening (FS) and left ventricular mass with the Penn convention formula. Measurements of left ventricular mass were divided by body surface area to obtain left ventricular mass index (LVmass index). We also evaluated parameters of RV and LV diastolic function including early and late atrioventricular (AV) flow velocities (E and A wave respectively), E/A ratio, deceleration time (DT) and isovolumic relaxation time (IVRT). Pulmonary artery systolic pressure (PASP) was estimated by the peak regurgitation velocity from the tricuspid valve plus the estimated right atrial pressure, while valve lessions by continuous and colour Doppler.
Results Twenty-three (29.5%) pts had mild mitral valve regurgitation versus 7 controls (p < 0.01), 6 pts had mild tricuspid regurgitation (p < 0.05) and 14 (18%) pts had mild aortic valve regurgitation. Pericardial effusion was found in 3 pts whereas fourteen (18%) pts had pulmonary hypertension (PASP >35 mmHg) (p < 0.001). Mitral valve regurgitation was significantly associated with the presence of the anti-La antibodies (p < 0.05) and pulmonary hypertension with lung disease (carbon monoxide diffusing capacity-2 vs 84.71 ± 15.36 gm-2, p < 0.001) and was correlated with the presence of purpura (P = 0.02), lung disease (p < 0.001) and the presence of rheumatoid factor (P = 0.02).
Conclusion Patients with pSS and no clinically apparent heart disease had, more often than healthy controls, mild mitral and tricuspid valve regurgitation, pulmonary hypertension, and had increased left ventricular mass index. The LV mass index is correlated with purpura, lung disease and the presence of rheumatoid factor.
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