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Circ Cardiovasc Imaging. 2016 Jun;9(6). pii: e003792. doi: 10.1161/CIRCIMAGING.115.003792. Epub 2016 Jun 7.

Unique Abnormalities in Right Ventricular Longitudinal Strain in Systemic Sclerosis Patients.

Author information

1
From the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (M.M., V.K.T., R.J.T., T.P.A.), Division of Pulmonary and Critical Care Medicine (S.-E.C.), and Division of Rheumatology (L.K.H., F.M.W., A.A.S.), Johns Hopkins University School of Medicine, Baltimore, MD. mmukher2@jhmi.edu.
2
From the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (M.M., V.K.T., R.J.T., T.P.A.), Division of Pulmonary and Critical Care Medicine (S.-E.C.), and Division of Rheumatology (L.K.H., F.M.W., A.A.S.), Johns Hopkins University School of Medicine, Baltimore, MD.

Abstract

BACKGROUND:

Cardiac involvement in systemic sclerosis (scleroderma [SSc]) adversely affects long-term prognosis, often remaining undetectable despite close clinical examination and 2-dimensional echocardiographic monitoring. Speckle-derived strain of the right ventricle (RV) was utilized to detect occult abnormalities in regional and global contractility in SSc patients.

METHODS AND RESULTS:

A total of 138 SSc patients with technically adequate echocardiograms was studied and compared with 40 age- and sex-matched healthy non-SSc controls. Standard assessment of RV chamber function included tricuspid annular plane systolic excursion and fractional area change. RV longitudinal systolic speckle-derived strain was assessed in the basal, mid, and apical free wall. Tricuspid annular plane systolic excursion was not different between groups (P=0.307). Although fractional area change was lower in SSc patients than in controls (mean, 48.9 versus 55; P=0.002), the mean fractional area change was still within the normal range (>35). In contrast, RV longitudinal systolic speckle-derived strain measures were significantly different between groups, both globally (-20.4% versus -17.7%; P=0.005) and regionally: they were decreased in the apex (-8.5% versus -17.1%; P<0.0001) and mid segments (-12.4% versus -20.9%; P<0.0001), and increased in the base (-32.2% versus -23.3%; P=0.0001) for the SSc group. The regional difference in the base compared with the apex was significantly greater for SSc than for controls (P<0.0001 for interaction). The differences observed in regional strain between SSc and control were unchanged after adjusting for RV systolic pressure.

CONCLUSIONS:

Speckle-derived strain reveals a heterogenous pattern of regional heart strain in SSc that is not detected by conventional measures of function, suggestive of occult RV myocardial disease.

KEYWORDS:

cardiomyopathies; heart ventricles; hypertension, pulmonary; scleroderma, systemic; ventricular function, right

PMID:
27266598
PMCID:
PMC4902176
DOI:
10.1161/CIRCIMAGING.115.003792
[Indexed for MEDLINE]
Free PMC Article

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