Echocardiographic alterations in systemic sclerosis: A longitudinal study

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Objective

To investigate the evolution of cardiac alterations in systemic sclerosis (SSc).

Methods

Echocardiographic and echo-Doppler findings from 77 unselected SSc patients were analyzed at the first clinical observation and after a follow-up period of 65 ± 36 months. Data were compared with those obtained from 45 normal subjects matched for age and sex.

Results

Baseline left ventricular (LV) systolic function was normal in all patients and controls while LV diastolic dysfunction (expressed by an inverted E/A ratio which represents early and late filling of the LV during atrial contraction) was present in 23 patients and in 1 control (P < 0.001). At the end of the follow-up period, while LV systolic function declined in 1 case alone, 6 further patients developed an inverted E/A ratio. Moreover, in the group of SSc patients mean A-wave values, E/A ratio, left atrial dimension, and LV wall thickness significantly changed, all indicating the progression of heart involvement. The alteration of LV diastolic function was independent of other known causes potentially affecting LV relaxation. Moreover, impairment of LV filling parameters was detected in the first phase of follow-up, while the anatomical changes occurred in the last phase.

Conclusions

Our data confirm the significant prevalence of LV diastolic dysfunction in SSc patients and the role of primary myocardial involvement. The long-term follow-up demonstrates that LV filling dysfunction is progressive and precedes the occurrence of LV remodeling.

Section snippets

Patients

The study group consisted of 77 consecutive patients (71 women and 6 men; mean age 54.4 years) with SSc diagnosed according to the American College of Rheumatology (ACR) criteria (18), admitted to the Rheumatology Unit at the Second University of Naples. Table 1 lists the main epidemiological and clinical features of these patients on entering the study. They were divided into 3 subsets according to the classification of Giordano and coworkers (19, 20, 21). The disease duration was assumed as

Data at presentation and comparison with controls

The main baseline echocardiographic and echo-Doppler parameters recorded in the 77 patients and 45 controls are reported in Table 2. Higher values of peak A (P < 0.001) and lower values of peak E (P = 0.02), with consequent reduction in the E/A ratio (P < 0.001) and a prolonged IRP and DT (each P < 0.001), were found in SSc patients than in controls (significance not reported in the table). An inverted E/A ratio was found in 23/77 SSc patients and 1/45 control subject (P < 0.001). Pericardial

Discussion

To our knowledge, this is the first long-term longitudinal study of echocardiographic alterations in patients with longstanding slowly evolving SSc. The baseline prevalence of anatomical alterations was similar to that reported in the majority of previous studies (5, 6, 9, 14, 15, 17). Moreover, we confirmed that LV systolic function was generally well preserved (28). but LV diastolic dysfunction was frequent (23/77). At the end of the follow-up, diastolic dysfunction occurred in 6 additional

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