Background Cardiac involvement is a main cause of mortality in systemic sclerosis (SSc)1. Its detection remains challenging using conventional echocardiographic parameters and little is known about which patients are at risk for deterioration of cardiac function. Speckle-tracking strain analysis of echocardiographic images can detect subtle myocardial dysfunction in patients with SSc, and decreased strain has been shown to associate with lower functional capacity and rhythm disturbances2
Objectives This study evaluated: 1. changes in cardiac performance over time in SSc patients including echocardiographic myocardial speckle tracking strain analysis, and 2. baseline characteristics associated with deterioration of cardiac function.
Methods 205 SSc patients (171 female, 52±14 years) were evaluated at baseline and follow-up (2.25years IQR1.3–3.8), including complete physical examination and screening for organ involvement with at least HRCT-thorax, pulmonary function test, cardiopulmonary exercise test, electrocardiography and echocardiography.
Results Left ventricular (LV) ejection fraction did not change significantly (61%±7 vs 61%±8,p=0.148) while global longitudinal strain (LS) decreased significantly (-21%±2 vs -19%±3, p<0.001). 39 patients showed progression of LV dysfunction as defined by ≥15% decline in LS. These patients showed significant worsening of LV diastolic function (figure) and TAPSE (22mm±4 vs 19mm±4, p=0.003) and 8% developed pulmonary hypertension. Baseline parameters associated with progression of LV dysfunction were proximal muscle weakness (OR: 4.264 IQR: 1.473–12.342, p=0.007), diffusing capacity of carbon monoxide (DLCO, OR: 0.972 IQR: 0.948–0.995, p=0.020) and LV diastolic dysfunction (OR: 2.245 IQR: 1.019–4.946, p=0.045).
Conclusions In SSc patients, progression of LV systolic dysfunction was detected by speckle tracking strain analysis but not by LV ejection fraction. Proximal muscle weakness, DLCO and LV diastolic function may identify patients at higher risk and in need of closer cardiac monitoring.
Rubio-Rivas M, Royo C et al. Mortality and survival in systemic sclerosis: systematic review and meta-analysis. Semin Arthritis Rheum 2014 Oct;44(2):208–19.
Yiu KH, Schouffoer AA, et al. Left ventricular dysfunction assessed by speckle-tracking strain analysis in patients with systemic sclerosis: relationship to functional capacity and ventricular arrhythmias. Arthritis Rheum 2011 Dec;63(12):3969–78.
Disclosure of Interest None declared