Bekir ÇALAPKORUR, Erkan DEMİRCİ, Samet KARAHAN, Kemal EROL, Tayfun AKALIN

Aşikâr pulmoner hipertansiyonu olmayan sistemik sklerozlu hastalarda tırnak kapilaroskopi bulguları ve modifiye Rodnan skoru sağ ventrikül fonksiyonlarında bozulma ile ilişkilidir

Amaç: Tırnak kapilloskopisi ve modifiye Rodnan skoru sistemik sklerozda (SS) çeşitli durumlarda klinik progresyon ile ilişkili bulunmuş olmasına rağmen sağ ventrikül fonksiyonları ile ilişkileri yeterince çalışılmamıştır. Bu çalışmada aşikar pulmoner hipertansiyonu olmayan sistemik sklerozlu hastalarda sağ ventrikül fonksiyonları ile modifiye Rodnan skoru, tırnak kapillaroskopisi gibi klinik SS klinik parametreleri ile arasındaki ilişki araştırılmıştır. Gereç ve Yöntem: Otuz iki SS’li hasta ve yirmi sağlıklı birey kontrol grubu için çalışmaya alınmıştır. Hastalar romatoloji uzmanı tarafından dijital ülserler, tırnak kapillaroskopisi ve deri tutulumu için değerlendirilmiştir. Tüm katılımcılara ekokardiyografik değerlendirme kardiyoloji uzmanı tarafından yapılmıştır. Ekokardiyografik parametreler Amerikan Ekokardiyografi Birliğinin kılavuzlarına göre hesaplanmıştır. Bulgular: Sistolik pulmoner arteriyel SS grubunda istatiksel olarak anlamlı şekilde yüksekti (26,4±3,2 vs 30,8±3,6 mmHg, p=0,001). Triküspit anüler plan sistolik hareketi (TAPSE), pulmoner akselerasyon zamanı ve ortalama sağ ventrikül strain değeri SS grubunda anlamlı olarak daha düşüktü (p=0,003, p=0,001, p=0,001). Kapillaroskopik olarak aktif ve geç patern ve geç paterne sahip hastalarda erken ve aktif paterne ve erken paterne sahip hastalara göre TAPSE, ventriküler isovolumik akselerasyon ve sağ ventrikül ortalama serbest duvar straini anlamlı olarak daha düşüktü (p=0,002, p=0,005, and p=0,001, sırasıyla) Univariat doğrusal regresyon analizde, SS grubunda modifiye Rodnan cilt skoru ile sağ ventrikül serbest duvar ortalama strain arasında anlamlı ilişki vardı (R2=0,192; p=0,007). Sonuç: Bu çalışmada SS’li hastalarda sistolik pulmoner arteriyel basınçta ve sağ ventrikül fonksiyonlarında erken dönemde bozulma olduğu gösterilmiştir. Ayrıca yüksek modifiye Rodnan cilt skoru ve geç dönem kapillaroskopik değişikliklerin sağ ventrikül fonksiyonlarındaki bozulmayla ilişkili olduğu bulunmuştur.

Anahtar Kelimeler:

Sistemik skleroz, tırnak kapillaroskopi, modifiye Rodnan cilt skoru, sağ ventrikül strain görüntüleme

Nailfold capillaroscopic pattern and modified Rodnan skin score associated with deterioration of right ventricle functions in systemic sclerosis patients without overt pulmonary hypertension

Objective: Although nailfold capillaroscopy (NC) and modified Rodnan skin score (mRSS) have already been studied in a variety of contexts related to Systemic Sclerosis (SSc) progression, there is limited data about the relationships between NC, mRSS, and right ventricle (RV) function in SSc patients without overt pulmonary arterial hypertension (PAH). In this study, we examined the relationship between RV function and clinical SSc parameters such as NC pattern and mRSS. Material and Method: Thirty two patients with SSc and twenty healthy participants as a control group were enrolled in this study. Patients with SSc were assessed for digital ulcers, Raynaud’s phenomenon, and severity of skin involvement by a rheumatology specialist. Also, all participants underwent echocardiographic examinations by cardiology specialists. The echo parameters were measured considering the criteria of the American Society of Echocardiography guidelines. Results: Systolic pulmonary arterial pressure (sPAP) was statistically higher in the SSc group (26.4±3.2 vs 30.8±3.6 mmHg, p

Keywords:

Systemic sclerosis, nailfold capillaroscopy, modified Rodnan skin score, right ventricle strain imaging,

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