Evaluation of left and right ventricle by two-dimensional speckle tracking echocardiography in systemic sclerosis patients without overt cardiac disease

• Published in: Clinical rheumatology Vol. 39; no. 1; pp. 37 - 48
• Main Authors: Karadag, Duygu Temiz, Sahin, Tayfun, Tekeoglu, Senem, Işik, Ozlem Ozdemir, Yazici, Ayten, Eraldemir, Fatma Ceyla, Cefle, Ayse
• Format: Journal Article
• Language: English
• Published: London Springer London 2020; Springer Nature B.V
• Subjects: Coronary artery disease; Echocardiography; Electrocardiography; Galectin-3; Heart diseases; Homocysteine; Inflammation; Medicine; Medicine & Public Health; Original Article; Rheumatology; Scleroderma; Systemic sclerosis; Updates in Systemic Sclerosis; Ventricle; Speckle tracking echocardiography; Right ventricle; Systemic sclerosis; Left ventricle; Systolic dysfunction
• DOI: 10.1007/s10067-019-04604-3
• ISSN: 0770-3198

Background/objective The aim was to evaluate the left and right ventricular functions concurrently by two-dimensional speckle tracking echocardiography (STE) in systemic sclerosis (SSc) patients without overt cardiac disease. Methods A total of 47 patients with SSc and 36 age- and sex-matched controls were evaluated cross-sectionally. Two-dimensional STE was used to assess the longitudinal peak systolic strains (PSS) of both ventricles including apical long-axis (APLAX), apical four-chamber (4-CH), apical two-chamber (2-CH), and global longitudinal measurements. Any association of metabolic, cardiac, and inflammatory biomarkers with PSS was investigated. Results The longitudinal PSS of the left ventricle [APLAX, 4-CH, 2-CH and global] were significantly lower in SSc patients than controls (− 18.2 ± 3.2 vs − 19.8 ± 2.7% p  = 0.02; − 17.8 ± 3.5 vs. − 20.3 ± 3.3% p  = 0.001; − 18.6 ± 3.1 vs. − 21.8 ± 3% p  < 0.001; − 17.5 ± 5.7 vs. − 20.6 ± 2.7% p  = 0.003, respectively). No difference was found between the groups for right ventricular strains. The longitudinal PSS-4CH correlated positively with CRP and ESR (r = 0.349, p  = 0.016; r = 0.356, p  = 0.014, respectively) and negatively with serum Galectin-3 ( r  = − 0.362, p  = 0.012). Global longitudinal PSS-left ventricle (LV) correlated positively with CRP and homocysteine ( r  = 0.297, p  = 0.043; r  = 0.313, p  = 0.041, respectively) and negatively with serum Galectin-3 ( r  = −0.314, p  = 0.041). After multivariable adjustment, CRP remained the only predictor of longitudinal PSS-4CH (95% CI 0.35, 0.70, p  = 0.028) and global longitudinal PSS of left ventricle (95% CI 0.004, 0.22, p  = 0.043). Conclusions Biventricular evaluation of patients with SSc by two dimensional STE revealed reduced left ventricular longitudinal strains, despite preserved right ventricular strain, and no diastolic dysfunction. In SSc without overt cardiac disease, global cardiac assessment with 2DSTE is a promising method which seems to contribute to the detection of patients without clinical findings. Key Points • Two dimensional STE revealed reduced left ventricular longitudinal strains, despite preserved right ventricular strain in SSc patients without overt cardiac disease . • CRP was the predictor of decreased longitudinal strains . • Cardiac assessment in SSc should be made globally .