Background Background. Measurement of myocardial deformation or Global longitudinal strain (GLS) by speckle tracking echocardiography (STE) is useful for detection of microvascular damage and myocardial contractility impairment in patients with ischemic cardiopathy. Primary antiphospholipid syndrome (PAPS) is characterized by thrombosis, endothelial and vascular dysfunction, accelerated atherosclerosis and subsequent cardiovascular damage. GLS has not been studied in these patients.
Objectives To evaluate the GLS of the left ventricle by STE in order to provide the early detection of myocardial dysfunction in patients with PAPS compared with healthy controls.
Methods Patients with PAPS older than 16 years of age, without signs and symptoms of heart failure and angina were recruited and matched with healthy controls by age and gender. Patients with uncontrolled thyroid disease, poor echocardiographic window, or pregnancy were excluded. Demographic, clinical data, cardiovascular risk factors and lipid profile were recorded. Standard transthoracic evaluation was done and images from GLS 2, 3 and 4 chambers view were recorded and analyzed with STE and strain imaging. Segmental strain (in 17 segments from the left ventricle), GLS2 chambers (represent the segments 4, 7, 10, 13, 15), GLS3 chambers (segments 2, 5, 8, 11, 13, 16), and GLS4 chambers (segments 3, 6, 9, 12, 14, 16), and average GLS were assessed. Mann Whitney U test was used to compare strain values.
Results Forty patients and 40 controls were included. Average age was 46.1±10.3 and 45.7±10.03 years respectively (p=NS). 80% of patients were females, disease evolution 12.53±6.98 years; history of thrombosis:deep venous thrombosis in 30 patients (70%) arterial thrombosis in 15 patients (37.5%),only one patient had previous myocardial infarction and 13 had stroke. The prevalence of obesity (48%) and dyslipidemia (43%) was higher in PAPS group than the control. Only 4 patients had arterial hypertension under control. The frequency of other risk factors was similar between groups. Ventricular ejection fraction was normal. In the PAPS group, myocardial segmental strain was lower in segments S10,S12,S13, S14, S15,S16, S17, and in echocardiographic views GLS2, GLS3, GSL4 chambers (p<.0.05). The average GLS was significantly lower in comparison with controls (p=0.001). GLS at segmental level, medium and apical was also lower in patients than controls (p=0.001).
Conclusions Patients with PAPS without signs and symptoms of heart disease had lower values of myocardial GLS than controls probably due to coronary microcirculation abnormalities. Speckle tracking echocardiography has a potential value in the assessment of subclinical myocardial dysfunction in PAPS patients.
Sitia S, Tomasoni L, Turiel M. Speckle tracking echocardiography: A new approach to myocardial function. World J Cardiol 2010; 2: 1-5
Disclosure of Interest None Declared
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