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Doppler-echo evaluation of left ventricular diastolic filling in patient with mixed connective tissue disease
Insights
Patients with mixed connective tissue disease (MCTD) show impaired left ventricular diastolic function, characterized by prolonged relaxation and altered filling patterns. These changes correlate with disease duration, suggesting early myocardial involvement in MCTD.
Area of Science:
- Cardiology
- Rheumatology
- Echocardiography
Background:
- Mixed Connective Tissue Disease (MCTD) can affect multiple organ systems.
- Cardiac involvement, particularly left ventricular diastolic dysfunction, is a potential complication of MCTD.
- Early detection of cardiac abnormalities is crucial for managing MCTD patients.
Purpose of the Study:
- To assess left ventricular diastolic function in patients with MCTD.
- To identify specific echocardiographic patterns of diastolic dysfunction in MCTD.
- To explore the relationship between diastolic function and disease duration in MCTD.
Main Methods:
- M-mode and pulsed Doppler echocardiography were used to evaluate diastolic function.
- 17 patients with MCTD were compared to 18 age- and sex-matched healthy controls.
- Key diastolic parameters including IVRT, peak E, peak A, and E/A ratio were measured.
Main Results:
- MCTD patients exhibited significantly prolonged isovolumic relaxation time (IVRT).
- Patients showed reduced peak early diastolic flow velocity (E) and increased peak late diastolic flow velocity (A), leading to a lower E/A ratio.
- Disease duration correlated significantly with IVRT, peak A, and velocity half-time.
Conclusions:
- Patients with MCTD demonstrate abnormal left ventricular diastolic filling patterns.
- These findings suggest potential myocardial involvement in MCTD, even without overt clinical heart disease.
- Diastolic dysfunction in MCTD may progress with disease duration.
Abstract:
Left ventricular diastolic function was assessed in 17 patients (2 males and 15 females; mean age 44 +/- 9 years) with mixed connective tissue disease (MCTD) and 18 sex- and age-matched healthy control subjects (2 males and 16 females; mean age 44 +/- 8 years) by means of M-mode and pulsed Doppler echocardiography. None had clinical evidence of overt myocardial disease or abnormal left ventricular systolic function. Compared with the control group, patients with MCTD had a significantly longer isovolumic relaxation time (IVRT) (59 +/- 7 versus 70 +/- 12 ms; p less than 0.01), a lower peak early diastolic flow velocity (E) (0.79 +/- 0.10 versus 0.70 +/- 0.07 m/s; p less than 0.005), a higher peak late diastolic flow velocity due to atrial contraction (A) (0.47 +/- 0.08 versus 0.54 +/- 0.08 m/s; p less than 0.05) and a reduced E/A ratio (1.72 +/- 0.37 versus 1.33 +/- 0.26; p less than 0.005). Although there was no significant correlation of left ventricular diastolic filling indexes with age, heart rate, left ventricular end-diastolic and end-systolic dimensions, interventricular septal and left ventricular posterior wall thickness, and fractional shortening, the duration of illness was significantly related to IVRT (r = 0.62; p less than 0.01), peak A (r = 0.79; p less than 0.001) and velocity half-time (r = 0.54; p less than 0.05). The results suggest the presence of an abnormal left ventricular diastolic filling pattern in patients with MCTD and may represent myocardial involvement in this disease.