Copyright © 2005, The European Society of Cardiology
Myocardial contractility is early affected in systemic sclerosis: A Tissue Doppler echocardiography study
aDepartment of Cardiology, Cochin Hospital, AP-HP, René Descartes University, 27 rue du Fg St-Jacques, 75014 Paris, France
bDepartment of Rheumatology A, Cochin Hospital, AP-HP, René Descartes University, 27 rue du Fg St-Jacques, 75014 Paris, France
cDepartment of Cardiology, Kremlin-Biçêtre Hospital, AP-HP, Kremlin-Biçêtre, France
dDepartment of Nuclear Medicine, Cochin Hospital, AP-HP, René Descartes University, 27 rue du Fg St-Jacques, 75014 Paris, France
Received 7 September 2004; received in revised form 12 December 2004; accepted after revision 29 December 2004.
* Corresponding author. Tel.: +33 1 58 41 16 21; fax: +33 1 58 41 16 05. christophe.meune{at}cch.ap-hop-paris.fr
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Abstract |
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Aims
Systemic sclerosis (SSc) is a connective tissue disorder characterized by frequent myocardial involvement. Alteration in left ventricular (LV) function is reported to be rare; however, it may be underestimated by conventional measurements. Our aim was to prospectively investigate LV function in SSc patients, using Tissue Doppler echocardiography (TDE), a modern and accurate method of assessing myocardial function.
Methods and results
Seventeen consecutive SSc patients with normal cardiac examination, pulmonary artery pressure (PAP) and radionuclide LV ejection fraction (EF) were prospectively investigated. Myocardial perfusion was investigated using single-photon-emission computerized tomography (SPECT). Echocardiography (ECHO), systolic and diastolic strain-rate (SR) measured in the posterior wall by TDE were used to investigate myocardial function, and compared with results of 15 matched controls.
All patients (53±8 years; 14 women; systolic PAP 33±6mmHg; LVEF 67±8%) had myocardial SPECT perfusion abnormalities. Despite normal ECHO, they had lower systolic SR than controls (1.7±0.5 versus 3.8±1.7cm–1, p<0.0001), and lower diastolic SR (3.7±1.5 versus 5.6±1.2cm–1, p=0.0004). Ten SSc patients had reduced systolic SR<1.7cm–1 and 11 reduced diastolic SR<3.5cm–1.
Conclusion
Frequent abnormal myocardial perfusion is confirmed in SSc patients. Reduced contractility is also frequent as detected by TDE, despite normal radionuclide LVEF.
Keywords: Echocardiography; Tissue Doppler; Systemic sclerosis; Left ventricular function
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