Right atrial morphology and function in patients with systemic sclerosis compared to healthy controls: a...

Area of Science:

• Cardiology
• Rheumatology
• Pulmonology

Background:

• Systemic sclerosis (SSc) is associated with cardiovascular complications.
• Right atrial enlargement and dysfunction may precede pulmonary hypertension in SSc.
• Early detection of cardiac involvement is crucial for managing SSc.

Purpose of the Study:

• To investigate right atrial morphology and function in SSc patients using 2D strain echocardiography (2DSE).
• To compare SSc patients with healthy controls at rest and during exercise.
• To correlate right atrial function with clinical findings, including pulmonary artery pressures.

Main Methods:

• Adult SSc patients (>3 years) and healthy controls underwent comprehensive non-invasive assessments.
• Included transthoracic echocardiography, pulsed Doppler myocardial imaging, and 2DSE at rest and during exercise.
• Serological tests and high-resolution chest CT were also performed.

Main Results:

• SSc patients exhibited significantly impaired right atrial function and enlargement compared to controls (p < 0.001).
• These impairments were more pronounced in SSc patients with pulmonary fibrosis and/or high exercise pulmonary artery systolic pressures (PAPs).
• Right atrial lateral strain correlated with exercise PAPs, right atrial area, left ventricle stroke volume, and IVC diameter.

Conclusions:

• A significant proportion of SSc patients display right atrial dysfunction, irrespective of manifest pulmonary hypertension.
• Impaired right atrial function is associated with pulmonary fibrosis, elevated exercise PAPs, and prognostic factors.
• 2DSE assessment of right atrial dysfunction may aid in early diagnosis and risk stratification for pulmonary hypertension in SSc.