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Left ventricular dysfunction and arrhythmias in asymptomatic patients with systemic sclerosis

Lilian López Núñez1, Irene Carrión-Barberà1, Luis Molina2

  • 1Rheumatology Department, Hospital del Mar/Parc de Salut Mar, Barcelona, Spain.

Medicina Clinica
|February 22, 2023
PubMed

Insights

Systemic sclerosis (SS) patients often have silent cardiac issues. Global longitudinal strain (GLS) detected more left ventricular systolic dysfunction (LVSD) in SS, suggesting early cardiac involvement.

Area of Science:

  • Cardiology
  • Rheumatology
  • Internal Medicine

Background:

  • Cardiac involvement in systemic sclerosis (SS) is a significant cause of mortality, often presenting asymptomatically.
  • Early detection of cardiac dysfunction and arrhythmias is crucial for managing SS patients.

Purpose of the Study:

  • To investigate the prevalence and associations of left ventricular dysfunction (LVD) and arrhythmias in asymptomatic SS patients without cardiovascular risk factors.
  • To evaluate the utility of global longitudinal strain (GLS) and cardiac biomarkers in detecting cardiac abnormalities in SS.

Main Methods:

  • A prospective study included 36 SS patients without cardiac symptoms or risk factors.
  • Evaluations included clinical assessment, blood tests (NT-proBNP, troponin T), electrocardiogram (EKG), Holter monitoring, and echocardiography with GLS.
  • Arrhythmias were classified as clinically significant (CSA) or non-significant.

Main Results:

  • Left ventricular diastolic dysfunction (LVDD) was present in 28%, LV systolic dysfunction (LVSD) by GLS in 22%, and cardiac dysautonomia in 16.7%.
  • EKG and Holter revealed alterations in 50% and 55.6% of patients, respectively, with 44% and 75% of these being CSA.
  • Elevated troponin T (TnTc) correlated with CSA, while elevated NT-proBNP and TnTc correlated with LVDD.

Conclusions:

  • Global longitudinal strain (GLS) identified a higher prevalence of LVSD in SS patients compared to ejection fraction (LVEF), highlighting its importance in routine evaluation.
  • Cardiac biomarkers NT-proBNP and TnTc may serve as minimally invasive markers for LVDD in SS.
  • The lack of correlation between LVD and CSA suggests arrhythmias may stem from early, independent cardiac involvement, warranting active investigation in all SS patients.
Abstract

Keywords:
Afectación cardiacaArrhythmiasArritmiasCardiac involvementDisautonomíaDisfunción ventricular izquierdaDysautonomiaEsclerodermiaEsclerosis sistémicaLeft ventricular dysfunctionSclerodermaSystemic sclerosis

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