A right ventricular diastolic impairment is common in systemic sclerosis and is associated with other target-organ damage

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• 作者：Christophe Meune ; MD ; PhD^a ; ^b ; ^c ; ^{christophe.meune@avc.aphp.fr" class="auth_mail" title="E-mail the corresponding author} ; Dinesh Khanna ; MD^d ; Jamil Aboulhosn ; MD^e ; Jé ; rô ; me Avouac ; MD ; PhD^f ; ^{javouac@me.com" class="auth_mail" title="E-mail the corresponding author} ; ^{jerome.avouac@cch.aphp.fr" class="auth_mail" title="E-mail the corresponding author} ; André ; Kahan ; MD^f ; Daniel E. Furst ; MD^e ; Yannick Allanore ; MD ; PhD^f
• 关键词：Systemic sclerosis ; Cardiovascular ; Echocardiography ; Myocardial involvement ; Diastolic dysfunction ; Right ventricle
• 刊名：Seminars in Arthritis and Rheumatism
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：45
• 期：4
• 页码：439-445
• 全文大小：261 K

文摘

Heart involvement in systemic sclerosis (SSc) is a strong prognostic factor. Our aim was to examine left ventricle (LV) and right ventricle (RV) involvement.

Methods

We examined LV and RV, systolic and diastolic functions, using echocardiography and Tissue-Doppler echocardiography (TDE) indexes, in a cohort of 212 consecutive SSc patients seen during a 9-month period at 2 institutions (Paris, France and Los Angeles, USA). They were compared to 50 healthy controls.

Results

When compared to controls, SSc patients had consistently impaired RV indices that include reduced RV contractility (p < 0.001), larger right atrial area (p = 0.027) and overall RV diastolic dysfunction (25% of SSc patients versus 0% of controls; p < 0.001). Patients also exhibited alterations in LV contractility and diastolic function (p < 0.001 each). In multivariate analysis, RV contractility as expressed by the TDE S_T parameter was associated with _TDE LV contractility S_M (p = 0.030), DLCO (p = 0.013) whereas RV diastolic impairment was associated with systolic pulmonary artery pressure (p = 0.015). A subgroup of 27 patients had proven pulmonary arterial hypertension (PAH); comparison between SSc-PAH versus SSc free of PAH patients revealed reduced LV diastolic function (transmitral E/A ratio, p = 0.045 and E_A < 10 cm/s, p = 0.029), reduced overall RV contractility (21.5% versus 4.5%; p = 0.03) and reduced RV diastolic function (transtricuspid E/A ratio; p = 0.014 and 68% versus 29% with impaired function; p = 0.001).

Conclusions

Our data show that RV is commonly affected in SSc with predominant impaired diastolic function. Several factors, including primary heart, lung vascular disease and pulmonary hypertension, contribute to such impairment.