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Contractile reserve in systemic sclerosis patients as a major predictor of global cardiac impairment and exercise tolerance

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Abstract

Several studies have evidenced high prevalence of myocardial systolic and diastolic dysfunction among patients with systemic sclerosis (SSc). Exercise echocardiography has shown a diagnostic and prognostic role in identifying early left ventricular (LV) dysfunction in several myocardial pathological settings. The aim of our study was to evaluate early signs of LV impairment under exercise and their correlation to patient’s exercise tolerance. Forty-five patients (age 60.4 ± 10.3 years) with SSc and 20 age and sex comparable controls were enrolled in the study. All patients underwent clinical evaluation, 2D echocardiography associated with Tissue Doppler and speckle tracking to evaluate LV deformation indexes, and an exercise echocardiography to evaluate left ventricle contractile reserve (LVCR) and exercise pulmonary pressures. Finally, a 6-minute walking test (6MWT) to evaluate exercise tolerance was also performed. Compared to controls, SSc patients showed an impaired diastolic function (E/E′ 10.9 ± 3.7 vs 8.36 ± 2.01; p < 0.01) associated with larger left atrial dimensions (LAVI 28.4 ± 8.7 vs 19.3 ± 4.6 mL/m2; p < 0.01). During exercise echocardiography, a reduced global longitudinal strain at peak exercise (S-GLS) was highlighted compared to controls (15.7 ± 3.6 vs 18.2 ± 2.2; p = 0.001). A S-GLS cutoff <18 %, identified by ROC analysis, identified SSc patients with a reduced diastolic function, exercise tolerance at the 6MWT and higher pulmonary pressures. Our data show that in SSc patients a reduced LVCR characterizes the patients with a more extensive cardiovascular impairment in terms of LV diastolic function, pulmonary pressures and exercise tolerance. These data underline the importance of exercise echocardiography for the preclinical screening of the LV impairment in this population.

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References

  1. van den Hoogen F, Khanna D, Fransen J et al (2013) 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum 65:2737–2747. doi:10.1002/art.38098

    Article  PubMed Central  PubMed  Google Scholar 

  2. Barnes J, Mayes MD (2012) Epidemiology of systemic sclerosis: incidence, prevalence, survival, risk factors, malignancy, and environmental triggers. Curr Opin Rheumatol 24:165–170. doi:10.1097/BOR.0b013e32834ff2e8

    Article  PubMed  Google Scholar 

  3. Tyndall AJ, Bannert B, Vonk M et al (2010) Causes and risk factors for death in systemic sclerosis: a study from the EULAR Scleroderma Trials and Research (EUSTAR) database. Ann Rheum Dis 69:1809–1815. doi:10.1136/ard.2009.114264

    Article  PubMed  Google Scholar 

  4. Hachulla E, Carpentier P, Gressin V et al (2009) Risk factors for death and the 3-year survival of patients with systemic sclerosis: the French ItinérAIR-Sclérodermie study. Rheumatology (Oxford) 48:304–308. doi:10.1093/rheumatology/ken488

    Article  Google Scholar 

  5. Bulkley BH, Ridolfi RL, Salyer WR, Hutchins GM (1976) Myocardial lesions of progressive systemic sclerosis. A cause of cardiac dysfunction. Circulation 53:483–490

    Article  CAS  PubMed  Google Scholar 

  6. Desai CS, Lee DC, Shah SJ (2011) Systemic sclerosis and the heart: current diagnosis and management. Curr Opin Rheumatol 23:545–554. doi:10.1097/BOR.0b013e32834b8975

    Article  PubMed Central  PubMed  Google Scholar 

  7. Mizuno R, Fujimoto S, Saito Y, Nakamura S (2010) Cardiac Raynaud’s phenomenon induced by cold provocation as a predictor of long-term left ventricular dysfunction and remodelling in systemic sclerosis: 7-year follow-up study. Eur J Heart Fail 12:268–275. doi:10.1093/eurjhf/hfp198

    Article  PubMed  Google Scholar 

  8. Blessberger H, Binder T (2010) NON-invasive imaging: two dimensional speckle tracking echocardiography: basic principles. Heart 96:716–722. doi:10.1136/hrt.2007.141002

    Article  PubMed  Google Scholar 

  9. Yiu KH, Schouffoer AA, Marsan NA et al (2011) Left ventricular dysfunction assessed by speckle-tracking strain analysis in patients with systemic sclerosis: relationship to functional capacity and ventricular arrhythmias. Arthritis Rheum 63:3969–3978. doi:10.1002/art.30614

    Article  PubMed  Google Scholar 

  10. Grünig E, Janssen B, Mereles D et al (2000) Abnormal pulmonary artery pressure response in asymptomatic carriers of primary pulmonary hypertension gene. Circulation 102:1145–1150

    Article  PubMed  Google Scholar 

  11. Gargani L, Pignone A, Agoston G et al (2013) Clinical and echocardiographic correlations of exercise-induced pulmonary hypertension in systemic sclerosis: a multicenter study. Am Heart J 165:200–207. doi:10.1016/j.ahj.2012.10.020

    Article  PubMed  Google Scholar 

  12. Voilliot D, Magne J, Dulgheru R et al (2014) Determinants of exercise-induced pulmonary arterial hypertension in systemic sclerosis. Int J Cardiol 173:373–379. doi:10.1016/j.ijcard.2014.02.042

    Article  PubMed  Google Scholar 

  13. Collins N, Bastian B, Quiqueree L, Jones C, Morgan R, Reeves G (2006) Abnormal pulmonary vascular responses in patients registered with a systemic autoimmunity database: pulmonary hypertension assessment and screening evaluation using stress echocardiography (PHASE-I). Eur J Echocardiogr 7:439–446. doi:10.1016/j.euje.2005.12.002

    Article  PubMed  Google Scholar 

  14. Ha JW, Lee HC, Kang ES et al (2007) Abnormal left ventricular longitudinal functional reserve in patients with diabetes mellitus: implication for detecting subclinical myocardial dysfunction using exercise tissue Doppler echocardiography. Heart 93:1571–1576. doi:10.1136/hrt.2006.101667

    Article  PubMed Central  PubMed  Google Scholar 

  15. Cadeddu C, Nocco S, Piano D et al (2013) Early impairment of contractility reserve in patients with insulin resistance in comparison with healthy subjects. Cardiovasc Diabetol 12:66. doi:10.1186/1475-2840-12-66

    Article  PubMed Central  PubMed  Google Scholar 

  16. Cadeddu C, Nocco S, Deidda M, Pau F, Colonna P, Mercuro G (2013) Altered transmural contractility in postmenopausal women affected by cardiac syndrome X. J Am Soc Echocardiogr 27:208–214. doi:10.1016/j.echo.2013.09.014

    Article  PubMed  Google Scholar 

  17. Mavrogeni S, Bratis K, van Wijk K et al (2012) Myocardial perfusion-fibrosis pattern in systemic sclerosis assessed by cardiac magnetic resonance. Int J Cardiol 3:e56–e58. doi:10.1016/j.ijcard.2011.12.039

    Article  Google Scholar 

  18. Tzelepis GE, Kelekis NL, Plastiras SC et al (2007) Pattern and distribution of myocardial fibrosis in systemic sclerosis: a delayed enhanced magnetic resonance imaging study. Arthritis Rheum 56:3827–3836. doi:10.1002/art.22971

    Article  PubMed  Google Scholar 

  19. Kahan A, Allanore Y (2006) Primary myocardial involvement in systemic sclerosis. Rheumatology (Oxford) 45(Suppl 4):14–17. doi:10.1093/rheumatology/kel312

    Google Scholar 

  20. Fernandes F, Ramires FJ, Arteaga E, Ianni BM, Bonfá ES, Mady C (2003) Cardiac remodeling in patients with systemic sclerosis with no signs or symptoms of heart failure: an endomyocardial biopsy study. J Card Fail 9:311–317. doi:10.1054/jcaf.2003.51

    Article  PubMed  Google Scholar 

  21. de Groote P, Gressin V, Hachulla E et al (2008) Evaluation of cardiac abnormalities by Doppler echocardiography in a large nationwide multicentric cohort of patients with systemic sclerosis. Ann Rheum Dis 67:31–36. doi:10.1136/ard.2006.057760

    Article  PubMed  Google Scholar 

  22. Meune C, Avouac J, Wahbi K et al (2008) Cardiac involvement in systemic sclerosis assessed by tissue-Doppler echocardiography during routine care: a controlled study of 100 consecutive patients. Arthritis Rheum 58:1803–1809. doi:10.1002/art.23463

    Article  PubMed  Google Scholar 

  23. Ciurzyński M, Bienias P, Lichodziejewska B et al (2008) Non-invasive diagnostic and functional evaluation of cardiac involvement in patients with systemic sclerosis. Clin Rheumatol 27:991–997. doi:10.1007/s10067-008-0837-9

    Article  PubMed  Google Scholar 

  24. Valentini G, Vitale DF, Giunta A et al (1996) Diastolic abnormalities in systemic sclerosis: evidence for associated defective cardiac functional reserve. Ann Rheum Dis 55:455–460

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  25. Can I, Onat AM, Aytemir K et al (2009) Detecting subclinical biventricular impairment in scleroderma patients by use of pulsed-wave tissue Doppler imaging. Tex Heart Inst J 36:31–37

    PubMed Central  PubMed  Google Scholar 

  26. Spethmann S, Dreger H, Schattke S et al (2012) Two-dimensional speckle tracking of the left ventricle in patients with systemic sclerosis for an early detection of myocardial involvement. Eur Heart J Cardiovasc Imaging 13:863–870. doi:10.1093/ehjci/jes047

    Article  PubMed  Google Scholar 

  27. Cusmà Piccione M, Zito C, Bagnato G et al (2013) Role of 2D strain in the early identification of left ventricular dysfunction and in the risk stratification of systemic sclerosis patients. Cardiovasc Ultrasound 11:6. doi:10.1186/1476-7120-11-6

    Article  PubMed Central  PubMed  Google Scholar 

  28. Akdogan A, Kaya EB, Sahin A et al (2011) Relationship between left ventricular diastolic dysfunction and six minute walk test in patients with systemic sclerosis. Int J Rheum Dis 14:379–383. doi:10.1111/j.1756-185X.2011.01672.x

    Article  PubMed  Google Scholar 

  29. Codullo V, Caporali R, Cuomo G et al (2013) Stress Doppler echocardiography in systemic sclerosis: evidence for a role in the prediction of pulmonary hypertension. Arthritis Rheum 65:2403–2411. doi:10.1002/art.38043

    Article  PubMed  Google Scholar 

  30. D’Alto M, Ghio S, D’Andrea A et al (2011) Inappropriate exercise-induced increase in pulmonary artery pressure in patients with systemic sclerosis. Heart 97:112–117. doi:10.1136/hrt.2010.203471

    Article  PubMed  Google Scholar 

  31. Hinchcliff M, Desai CS, Varga J, Shah SJ (2012) Prevalence, prognosis, and factors associated with left ventricular diastolic dysfunction in systemic sclerosis. Clin Exp Rheumatol 30:S30–S37

    PubMed Central  PubMed  Google Scholar 

  32. Költő G, Faludi R, Aradi D et al (2014) Impact of cardiac involvement on the risk of mortality among patients with systemic sclerosis: a 5-year follow-up of a single-center cohort. Clin Rheumatol 33:197–205. doi:10.1007/s10067-013-2358-4

    Article  PubMed  Google Scholar 

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Conflict of interest

All authors have no conflict of interest to disclose.

Ethical standard

The study was approved by the Ethics Committee of the University Hospital, University of Cagliari. Written informed consent was obtained from all patients involved. The study was carried out in accordance with the Declaration of Helsinki.

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Authors and Affiliations

  1. Department of Medical Sciences “M. Aresu”, University of Cagliari, Strada Statale 554, Km 4.500, 09042, Monserrato, Cagliari, Italy

    Christian Cadeddu, Martino Deidda, Giuseppina Giau, Marzia Lilliu, Fabio Cadeddu, Giulio Binaghi, Mario Nicola Mura, Michela Farci, Stefano Del Giacco, Paolo Emilio Manconi & Giuseppe Mercuro

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  1. Christian Cadeddu
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  2. Martino Deidda
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  3. Giuseppina Giau
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Correspondence to Christian Cadeddu.

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Cadeddu, C., Deidda, M., Giau, G. et al. Contractile reserve in systemic sclerosis patients as a major predictor of global cardiac impairment and exercise tolerance. Int J Cardiovasc Imaging 31, 529–536 (2015). https://doi.org/10.1007/s10554-014-0583-9

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  • DOI: https://doi.org/10.1007/s10554-014-0583-9

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