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[Electrocardiographic and echocardiographic evaluation of cardiac changes in systemic scleroderma]
Insights
Systemic scleroderma patients frequently exhibit cardiac abnormalities, particularly impaired diastolic function. These findings, including electrocardiographic and echocardiographic changes, were consistent across different scleroderma types.
Area of Science:
- Cardiology
- Rheumatology
- Internal Medicine
Background:
- Systemic scleroderma is a connective tissue disease with potential multi-organ involvement.
- Cardiac complications are a significant cause of morbidity and mortality in systemic scleroderma patients.
- Previous studies have indicated cardiac involvement, but detailed functional analysis is less understood.
Purpose of the Study:
- To investigate the prevalence and characteristics of cardiac abnormalities in patients with systemic scleroderma.
- To compare electrocardiographic (ECG) and echocardiographic findings between systemic scleroderma patients and a control group.
- To assess cardiac function, particularly diastolic and systolic function, in relation to scleroderma subtypes.
Main Methods:
- Clinical examination, electrocardiography (ECG), and echocardiography were performed on 66 patients with systemic scleroderma.
- Cardiac parameters including ventricular hypertrophy, myocardial infarction patterns, diastolic movement, pericardial effusion, and relaxation times were analyzed.
- Statistical comparisons were made between patient groups and, where applicable, with control data.
Main Results:
- Abnormal ECG findings were present in 62.1% of patients, with ventricular extrasystole and conduction blocks being common.
- Echocardiography revealed abnormalities in 57.6% of patients, notably sluggish diastolic movement, pericardial effusion, and prolonged isovolumic relaxation time.
- No significant differences in left ventricular systolic function indices (ejection fraction, VCF) were observed between scleroderma patients and controls.
- Diastolic dysfunction was more prevalent than systolic dysfunction, and cardiac abnormalities showed similar prevalence across different scleroderma subtypes.
Conclusions:
- Systemic scleroderma frequently causes cardiac abnormalities, with a notable prevalence of diastolic dysfunction.
- Electrocardiographic and echocardiographic findings suggest impaired diastolic rather than systolic left ventricular function.
- The similar prevalence of cardiac abnormalities across various scleroderma types challenges common assumptions and warrants further investigation.
Abstract:
Cardiac abnormalities were studied using the clinical, electrocardiographic and echocardiographic methods in 66 patients with systemic scleroderma. Abnormal ecg was seen in 41 patients (62.1%), most frequently in form ventricular extrasystole (21.2%), incomplete block of the right bundle branch (12.1%), left ventricular and right atrial hypertrophy (10.6%) each, and the pattern suggesting the history of past myocardial infarction (7.6%). Abnormal echocardiographic results were found in 38 patients (57.6%). The most usual changes, differentiating that group from the controls, were: sluggish diastolic movement of the posterior wall of the left ventricle (40.7%), pericardial effusion (37.0%), elongation of the isovolumic relaxation time diastole phase (99.3 s.m.v. 81.1 ms, p less than 0.001) and right ventricular dilatation. There were no significant differences between the scleroderma and the control group as regards the indices of the contractility of the left ventricle: ejection fraction (EF), velocity of circumferential fibres shortening (VCF), diastolic size of the left ventricle and of the left atrium. The prevalence of the electrocardiographic and echocardiographic abnormalities in particular types of scleroderma (diffuse, acroscleroderma, severe acroscleroderma, CREST) was roughly similar: 50-76%. Finding of the impaired diastolic rather than systolic function of the left ventricle and of the similar prevalence of the cardiac abnormalities in the particular types of scleroderma is new and contradictory to the commonplace opinions.