Tissue Doppler imaging in systemic sclerosis: A 3-year longitudinal study

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• 作者：Michele D&rsquo ; Alto ; MD ; PhD^a ; Giovanna Cuomo ; MD^b ; Emanuele Romeo ; MD ; PhD^a ; Paola Argiento ; MD ; PhD^a ; Michele Iudici ; MD^b ; Serena Vettori ; MD ; PhD^b ; Maria Giovanna Russo ; MD^a ; Raffaele Calabrò ; MD^a ; Gabriele Valentini ; MD^b ; ^{gabriele.valentini@unina2.it" class="auth_mail}
• 关键词：Systemic sclerosis ; Tissue Doppler imaging ; Ventricular function ; Pulmonary artery systolic pressure
• 刊名：Seminars in Arthritis and Rheumatism
• 出版年：April, 2014
• 年：2014
• 卷：43
• 期：5
• 页码：673-680
• 全文大小：255 K

文摘

Objectives

To investigate by standard echocardiography and pulsed-tissue Doppler imaging (TDI) the course of systemic sclerosis (SSc) heart disease and its correlation with epidemiological, clinical, and serological features of the disease and drug treatment.

Methods

A total of 74 consecutive patients (69 females, between the ages of 19 and 71 years, and disease duration 1-43 years) and 71 controls underwent cardiac assessment at baseline and at 3-year follow-up.

Results

At baseline, compared to controls, patients showed post-Bonferroni correction, impaired left (LV) and right ventricular (RV) diastolic function (E_m/A_m 0.85 卤 0.4 vs 1.5 卤 0.7, p = 0.0003; E_t/A_t 0.9 卤 0.3 vs 1.3 卤 0.4, p = 0.0003), subtle LV and RV systolic dysfunction (S_m 13.7 卤 2.7 vs 15.4 卤 3.2 cm/s, p = 0.031; S_t < 11.5 cm/s in 16/74 patients vs 0 controls, p = 0.0031), and higher pulmonary artery systolic pressure (sPAP) (26.1 卤 6.0 vs 24.1 卤 5.1, p = 0.040). At 3-year follow-up, SSc patients showed a further deterioration of biventricular diastolic and systolic function and a further sPAP increase. At multiple regression analysis of baseline data, E_m/A_m < 1 was detected in 55/74 patients vs 25/71 controls (p < 0.0001) and was associated with age (p = 0.030); E_t/A_t < 1 was detected in 16/74 patients vs 7/71 controls (p < 0.0001), was associated with NYHA class 鈮?II (p = 0.033), late capillaroscopic pattern (p = 0.029), and a baseline cardiac Medsger severity score 鈮?1 (p = 0.029). TDI evidence of new abnormalities in RV and/or LV diastolic function was associated with a baseline cardiac Medsger severity score 鈮?1 (p = 0.01). Neither diastolic or systolic abnormalities nor sPAP changes correlated with treatment.

Conclusions

Our study confirms that SSc patients exhibit biventricular systolic and diastolic dysfunction and increased sPAP and reveals further deterioration at 3-year follow-up.