Background The pathophysiological hallmarks of systemic sclerosis (SSc), i.e. functional and morphological vascular alterations, systemic inflammation and aberrant collagen deposition may affect the cardiovascular system and produce an array of clinical manifestations, e.g. pulmonary arterial hypertension, restrictive cardiomyopathy, conduction heart disturbances or premature atherosclerosis.
Objectives To investigate cardiac structural and functional parameters in SSc patients without clinically evident heart disease.
Methods SSc patients and age- and sex-matched healthy controls underwent transthoracic echocardiography for the evaluation of left ventricular (LV) morphology and function, of cardiac valves and for the estimation of pulmonary systolic arterial pressure (PASP). Additionally, patients underwent stress-rest myocardial perfusion imaging (MPI) scintigraphy by single-photon emission computed tomography (SPECT) for the detection of reversible myocardial perfusion defects.
Results Thirty-three female and 4 male SSc patients with a mean age of 54.4 years and 37 matched controls were studied. Nineteen patients had diffuse and 18 limited SSc, with a mean disease duration of 18.6 years. Echocardiography revealed LV hypertrophy in 9 patients (24.3%), but in none of the controls (p=0.001) and LV diastolic dysfunction in 17 (45.9%) patients and 15 (40.5%) controls (p=0.639). After exclusion of patients with arterial hypertension, LV hypertrophy was still found in 23.1% (p=0.002 vs controls) and LV diastolic dysfunction in 38.5% (p=0.868 vs controls). Median LV ejection fraction (EF) was 67% (range 50-80) and 66% (range 54-78) in patients and controls respectively (p=0.436). SSc patients had median PASP 30 (range 20-51) mmHg, while controls had median PASP 20 (14-28) mmHg (p<0.001). Of the 35 SSc patients who underwent scintigraphic MPI, 21 patients (60%) exhibited reversible LV perfusion defects. Their mean age was 51.8 years. In all cases ischemia was graded as mild or moderate and in only one case as significant. There were no statistically significant differences regarding demographics, echocardiography or autoantibody profile between patients with and without ischemia.
Conclusions Left ventricular hypertrophy and raised PASP were more common in SSc patients than healthy controls. Moreover diastolic dysfunction and reversible ischemia were found in a significant proportion in this group of mostly female middle-aged SSc patients. A high level of awareness for subclinical heart involvement is warranted when treating patients with SSc.
Disclosure of Interest: None Declared
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