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Heart involvement in systemic sclerosis: an ultrasonic tissue characterisation study
C Ferri1, V Di Bello, A Martini
1Department of Internal Medicine, University of Pisa, Italy.
Annals of the Rheumatic Diseases
|September 19, 1998
Summary
Systemic sclerosis (SSc) patients show early preclinical heart changes detected by ultrasonic videodensitometry. This non-invasive method identifies myocardial alterations, potentially predicting future cardiac events in SSc patients.
Area of Science:
- Cardiology
- Rheumatology
- Medical Imaging
Background:
- Systemic sclerosis (SSc) significantly impacts prognosis, with symptomatic heart involvement indicating poor outcomes.
- Autopsy reveals high rates of myocardial fibrosis in SSc patients, yet clinical detection of heart disease is lower.
- A discrepancy exists between clinical findings and autopsy results regarding myocardial fibrosis in SSc.
Purpose of the Study:
- To detect preclinical myocardial alterations in systemic sclerosis (SSc) patients using ultrasonic videodensitometric analysis.
- To investigate early, subclinical cardiac changes in SSc patients before overt ventricular dysfunction appears.
Main Methods:
- Thirty-five SSc patients with normal ventricular function and 25 healthy controls underwent echocardiography.
- Quantitative texture analysis of echocardiographic images was performed, calculating the cyclic variation index (CVI).
- Exclusion criteria included arterial hypertension, renal involvement, and diabetes; all patients had negative maximal exercise stress tests.
Main Results:
- SSc patients exhibited significantly lower cyclic variation index (CVI) values compared to controls in both the septum and posterior wall (p < 0.0001).
- Eighty-eight percent of SSc patients showed changes in cyclic echo amplitude, suggesting myocardial fibrosis.
- Left ventricular mass, blood pressure, and systolic/diastolic functions were comparable between SSc patients and controls.
Conclusions:
- Ultrasonic videodensitometric analysis is a feasible, non-invasive method for detecting early myocardial changes in SSc patients.
- These early changes may be linked to myocardial fibrosis and microcirculatory abnormalities.
- Further research is needed to explore the progression of these changes towards ventricular dysfunction and their association with cardiac sudden death in SSc.