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Right ventricular and atrial functions in systemic sclerosis patients without pulmonary hypertension

Speckle-tracking echocardiographic study

Rechtsventrikuläre und Vorhoffunktion bei Patienten mit systemischer Sklerose ohne pulmonale Hypertonie

Untersuchung mit der Speckle-Tracking-Echokardiographie

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Abstract

Background

Systemic sclerosis (SSc) is a systemic connective tissue disease and cardiac involvement is one of the most important causes of death. Right ventricular (RV) systolic dysfunction is a poor prognostic finding in SSc patients. Assessment of RV function has some difficulties because of its crescent shape and extensive trabeculations. Two-dimensional (2D) speckle-tracking echocardiography (STE) is an angle-independent quantitative technique to evaluate myocardial function. The aim of this study was to assess the RV and right atrial (RA) functions of SSc patients without pulmonary hypertension by using 2D STE.

Patients and methods

A total of 40 patients with SSc (mean age 48.5 ± 11.4 years, 28 female) and 40 healthy volunteers (mean age 45.9 ± 7.6 years, 21 female) were included in the study. All subjects underwent transthoracic echocardiography for evaluation of RV and RA functions with 2D STE.

Results

Although left ventricular systolic and diastolic functions, systolic pulmonary artery pressure (PAP), and RA measurements were similar in both groups, tricuspid annular plane systolic excursion (TAPSE) and maximum systolic myocardial velocity (S’) were decreased in SSc patients. The RV free wall global longitudinal strain (GLS) of SSc patients was lower than the controls (− 18.5 ± 4.9 % vs. − 21.8 ± 2.4 %, p < 0.001) and the RA reservoir and conduit functions were also decreased in SSc patients compared with controls (34.4 ± 9.9 % vs. 39.7 ± 11.2 %, p = 0.027 and 15.0 ± 5.7 % vs. 18.7 ± 6.4 %, p = 0.009, respectively). Disease duration was inversely correlated with RVGLS and TAPSE (r: − 0.416, p = 0.018 and r: − 0.383, p = 0.031, respectively).

Conclusion

The use of 2D STE can be helpful in the detection of impairment in RV and RA functions in SSc patients with normal PAP.

Zusammenfassung

Hintergrund

Die systemische Sklerose (SSc) ist eine systemische Bindegewebserkrankung, und die Herzbeteiligung stellt eine der Haupttodesursachen dar. Eine rechtsventrikuläre (RV) systolische Funktionseinschränkung ist ein Befund, der bei SSc-Patienten für eine schlechte Prognose steht. Die Untersuchung der RV-Funktion ist aufgrund der Halbmondform und ausgedehnter Trabekulierungen des RV schwierig. Die zweidimensionale (2-D-)Speckle-Tracking-Echokardiographie (STE) ist eine winkelunabhänigige quantitative Untersuchungstechnik für die Myokardfunktion. Ziel dieser Studie war es, die Funktion des RV und des rechten Vorhofs (RA) bei SSc-Patienten ohne pulmonale Hypertonie mittels 2-D-STE zu ermitteln.

Patienten und Methoden

In die Studie wurden 40 Patienten mit SSc (Durchschnittsalter: 48,5 ± 11,4 Jahre, 28 w) und 40 gesunde Kontrollen (Durchschnittsalter: 45,9 ± 7,6 Jahre, 21 w) aufgenommen. Bei allen Teilnehmern wurden die RV- und RA-Funktion mittels transthorakaler Echokardiographie in Kombination mit 2-D-STE untersucht.

Ergebnisse

Die linksventrikuläre systolische und diastolische Funktion, der systolische Pulmonalarteriendruck (PAP) und die RA-Messungen waren in beiden Gruppen zwar ähnlich, aber die systolische Exkursion auf der Ebene des Trikuspidalrings (TAPSE) und die maximale systolische Myokardgeschwindigkeit (S‘) waren bei SSc-Patienten vermindert. Der globale longitudinale Strain (GLS) der freien RV-Wand war bei SSc-Patienten geringer als bei den Kontrollen (− 18,5 ± 4,9 % vs. − 21,8 ± 2,4 %; p < 0,001) und auch die Reservoir- und Conduitfunktion war bei den SSc-Patienten gegenüber den Kontrollen vermindert (34,4 ± 9,9 % vs. 39,7 ± 11,2 %; p = 0,027 bzw. 15,0 ± 5,7 % vs. 18,7 ± 6,4 %; p = 0,009). Die Krankheitsdauer stand in inverser Korrelation mit dem RV-GLS und TAPSE (r − 0,416; p = 0,018 bzw. r − 0,383; p = 0,031).

Schlussfolgerung

Der Einsatz der 2-D-STE könnte zur Erkennung einer Einschränkung der RV- und RA-Funktion bei SSc-Patienten mit normalem PAP von Nutzen sein.

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Compliance with ethical guidelines

Conflict of interest. E. Durmus, M. Sunbul, K. Tigen, T. Kivrak, G. Ozen, I. Sari, H. Direskeneli, and Y. Basaran state that there are no conflicts of interest. All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Authors and Affiliations

  1. Faculty of Medicine, Department of Cardiology, Marmara University, Fevzi Cakmak Mahallesi, Mimar Sinan Caddesi, No: 41 Ustkaynarca, Pendik, Istanbul, Turkey

    E. Durmus, M. Sunbul MD, K. Tigen, T. Kivrak, I. Sari & Y. Basaran

  2. Faculty of Medicine, Department of Rheumatology, Marmara University, Istanbul, Turkey

    G. Ozen & H. Direskeneli

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  1. E. Durmus
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Correspondence to M. Sunbul MD.

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Durmus, E., Sunbul, M., Tigen, K. et al. Right ventricular and atrial functions in systemic sclerosis patients without pulmonary hypertension. Herz 40, 709–715 (2015). https://doi.org/10.1007/s00059-014-4113-2

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