Right heart function in scleroderma: insights from myocardial Doppler tissue imaging.

Area of Science:

• Cardiology
• Rheumatology
• Medical Imaging

Background:

• Progressive systemic sclerosis (SSc) frequently affects the heart, leading to significant morbidity.
• Right ventricular (RV) dysfunction is a known complication, but its early detection and prognostic implications require further study.

Purpose of the Study:

• To evaluate heart function using Doppler tissue imaging (DTI) in patients with SSc.
• To assess the predictive value of DTI parameters for rehospitalization rates in SSc.

Main Methods:

• A study of 40 SSc patients and 45 controls using chest roentgenography, pulmonary function tests, echocardiography, and DTI.
• Pulsed wave Doppler tissue imaging assessed RV and septal velocities, including peak systolic myocardial velocity (Sm).
• Right ventricular ejection fraction (RVEF) and left ventricular ejection fraction (LVEF) were calculated using Simpson's method.

Main Results:

• SSc patients showed significant differences in echocardiographic and DTI parameters compared to controls, particularly in RV function.
• Decreased RV parameters, including RV-Sm, were observed in SSc patients, indicating RV systolic dysfunction.
• RV-Sm < 11 cm/s accurately predicted RVEF < 40% (sensitivity 87%, specificity 86%), and RV-Sm < 12 cm/s correlated inversely with hospitalization frequency.

Conclusions:

• RV systolic dysfunction is prevalent in SSc, likely due to pulmonary hypertension, microcirculation disturbances, and fibrosis.
• DTI, specifically RV-Sm, is a valuable tool for identifying RV failure and predicting rehospitalization risk in SSc.
• Early cardiac involvement in SSc, assessed by DTI, suggests a systemic process affecting multiple organs.