Detecting subclinical biventricular impairment in scleroderma patients by use of pulsed-wave tissue Doppler imaging

Systemic scleroderma is a disease that is characterized by excessive fibroblastic activity and collagen deposition in various organs, including the heart. We sought to evaluate the limits of biventricular function as derived noninvasively from pulsed-wave tissue Doppler imaging (TDI) of tricuspid and mitral annular motion in patients who had scleroderma.We enrolled 24 patients with scleroderma (study group; mean age, 49 +/- 11 yr; 20 women) and 24 healthy participants (control group; mean age, 51 +/- 9 yr; 19 women). Persons with cardiovascular risk factors were excluded. We obtained images by conventional echocardiography and by pulsed-wave TDI, measuring the respective peak systolic velocities (S, Sm) and peak early (E, Em) and late (A, Am) diastolic velocities. Mean Sm, mean Em, and mean Am were averages of the 4 measured sites (anterior, inferior, lateral, and septal). We calculated noninvasive estimates of left ventricular (LV) filling pressure by dividing E velocities (from the mitral inflow) by Em velocities (E/Em ratios).Biventricular regional Sm, regional LV myocardial Em, and ratios of myocardial Em/atrial component velocity (Em/Am) for the LV, and mean Sm, mean Em, and mean Em/mean Am ratios for the LV were significantly lower in the study group. The E/Em ratio was higher in the study group (7.3 +/- 2.6 vs 5.2 +/- 1.0, P = 0.01). Global LV systolic and diastolic function did not differ between the groups.Tissue Doppler imaging complements conventional echocardiography in detecting subclinical biventricular impairment in patients with scleroderma who have normal global measurements.