Burak ERER, Betül ERER, Hüseyin OFLAZ, Şevket GÖRGÜLÜ, Sevil KAMALI, ÖZCAN KARAMAN, Murat İNANÇ

Assessment of subclinical cardiac dysfunction in diffuse scleroderma patients

Amaç: Asemptomatik diffüz skleroderma (SSc) hastalarında sağ ve sol ventrikül fonksiyonlarının değişik ekokardiyografik yöntemler ile değerlendirilmesi amaçlanmıştır. Hastalar ve Yöntemler: Çalışmaya kardiyak açıdan asemptomatik olan 20 diffüz SSc tanılı ayaktan hasta ile 20 sağlıklı kontrol dahil edildi. Konvansiyonel ekokardiyografik yöntemler ile sol (LV) ve sağ (RV) ventrikül ölçümleri, doku Doppler görüntüleme (TDI) ve miyokard performans indeksleri (MPI) değerlendirildi. Bulgular: Skleroderma tanılı hastalarda hem sol hem de sağ ventrikül diyastolik fonksiyonları belirgin olarak azalmış olmakla birlikte, LV sistolik fonksiyonları her iki grupta benzer bulundu. SSc hastalarının %25'inde pulmoner arter basıncının artmış olduğu gözlendi (31.1±5.2 ve 24.7±2.7 mmHg, p

Diffüz skleroderma hastalarında subklinik kardiyak fonksiyonların değerlendirilmesi

Objectives: We aimed to evaluate left and right ventricular functions with different echocardiographic methods in asymptomatic patients with diffuse scleroderma (SSc). Patients and Methods: Twenty diffuse SSc outpatients, asymptomatic with regard to cardiac symptoms and twenty healthy control subjects were enrolled. Conventional left ventricular (LV) and right ventricular (RV) echocardiographic measurements, pulsed wave tissue Doppler imaging (TDI) and myocardial performance indexes (MPI) were evaluated. Results: Both left (LV early to atrial peak velocity ratio: p<0.02, LV isovolumic relaxation time: p<0.03, LV deceleration time: p<0.02) and right ventricle (RV early to atrial peak velocity ratio: p<0.02) diastolic functions were significantly reduced in SSc group while the parameters assessing LV systolic function were similar in both groups. Pulmonary artery pressure was significantly higher in 25% of SSc patients (31.1±5.2 and 24.7±2.7 mmHg, p<0.001). Although mitral and tricuspid annular systolic velocities with TDI (Sm, St) were similar between two groups, obtained diastolic functions showed a decrease in SSc patients. Tei index was statistically higher in SSc group (left ventricle MPI (LV-MPI): p<0.03 and right ventricle MPI (RV-MPI): p<0.007). Conclusion: Diastolic dysfunction of both ventricles with different echocardiographic methods was observed in diffuse SSc patients even without cardiac symptoms.

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1) Arias-Nuñez MC, Llorca J, Vazquez-Rodriguez TR, Gomez- Acebo I, Miranda-Filloy JA, Martin J, et al. Systemic sclerosis in northwestern Spain: a 19-year epidemiologic study. Medicine 2008;87:272-80.
2) Hesselstrand R, Scheja A, Akesson A. Mortality and causes of death in a Swedish series of systemic sclerosis patients. Ann Rheum Dis 1998;57:682-6.
3) Meune C, Avouac J, Wahbi K, Cabanes L, Wipff J, Mouthon L, et al. Cardiac involvement in systemic sclerosis assessed by tissue-doppler echocardiography during routine care: A controlled study of 100 consecutive patients. Arthritis Rheum 2008;58:1803-9.
4) D'Angelo WA, Fries JF, Masi AT, Shulman LE. Pathologic observations in systemic sclerosis (scleroderma). A study of fifty-eight autopsy cases and fifty-eight matched controls. Am J Med 1969;46:428-40.
5) Bulkley BH, Ridolfi RL, Salyer WR, Hutchins GM. Myocardial lesions of progressive systemic sclerosis. A cause of cardiac dysfunction. Circulation 1976;53:483-90.
6) Deswal A, Follansbee WP. Cardiac involvement in scleroderma. Rheum Dis Clin North Am 1996;22:841-60.
7) Kahan A, Allanore Y. Primary myocardial involvement in systemic sclerosis. Rheumatology 2006;45 Suppl 4:iv14-7.
8) Preliminary criteria for the classification of systemic sclerosis (scleroderma). Subcommittee for scleroderma criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Committee. Arthritis Rheum 1980;23:581-90.
9) Henry WL, DeMaria A, Gramiak R, King DL, Kisslo JA, Popp RL, et al. Report of the American Society of Echocardiography Committee on Nomenclature and Standards in Two-dimensional Echocardiography. Circulation 1980;62:212-7.
10) Sahn DJ, DeMaria A, Kisslo J, Weyman A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 1978;58:1072-83.
11) Di Bello V, Lattanzi F, Picano E, Talarico L, Caputo MT, Di Muro C, et al. Left ventricular performance and ultrasonic myocardial quantitative reflectivity in endurance senior athletes: an echocardiographic study. Eur Heart J 1993;14:358-63.
12) Yock PG, Popp RL. Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation 1984;70:657-62.
13) Alam M, Wardell J, Andersson E, Samad BA, Nordlander R. Characteristics of mitral and tricuspid annular velocities determined by pulsed wave Doppler tissue imaging in healthy subjects. J Am Soc Echocardiogr 1999;12:618-28.
14) Tei C. New non-invasive index for combined systolic and diastolic ventricular function. J Cardiol 1995;26:135-6.
15) Tei C, Dujardin KS, Hodge DO, Bailey KR, McGoon MD, Tajik AJ, et al. Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr 1996;9:838-47.
16) Lindqvist P, Caidahl K, Neuman-Andersen G, Ozolins C, Rantapää-Dahlqvist S, Waldenström A, et al. Disturbed right ventricular diastolic function in patients with systemic sclerosis: a Doppler tissue imaging study. Chest 2005;128:755-63.
17) Maione S, Cuomo G, Giunta A, Tanturri de Horatio L, La Montagna G, Manguso F, et al. Echocardiographic alterations in systemic sclerosis: a longitudinal study. Semin Arthritis Rheum 2005;34:721-7.
18) D'Andrea A, Caso P, Cuomo S, Scotto di Uccio F, Scarafile R, Salerno G, et al. Myocardial and vascular dysfunction in systemic sclerosis: the potential role of noninvasive assessment in asymptomatic patients. Int J Cardiol 2007;121:298-301.
19) Alexander EL, Firestein GS, Weiss JL, Heuser RR, Leitl G, Wagner HN Jr, et al. Reversible cold-induced abnormalities in myocardial perfusion and function in systemic sclerosis. Ann Intern Med 1986;105:661-8.
20) Gustafsson R, Mannting F, Kazzam E, Waldenström A, Hällgren R. Cold-induced reversible myocardial ischaemia in systemic sclerosis. Lancet 1989;2:475-9.
21) Belloli L, Carlo-Stella N, Ciocia G, Chiti A, Massarotti M, Marasini B. Myocardial involvement in systemic sclerosis. Rheumatology 2008;47:1070-2.
22) Proudman SM, Stevens WM, Sahhar J, Celermajer D. Pulmonary arterial hypertension in systemic sclerosis: the need for early detection and treatment. Intern Med J 2007;37:485-94.
23) Morelli S, Barbieri C, Sgreccia A, Ferrante L, Pittoni V, Conti F, et al. Relationship between cutaneous and pulmonary involvement in systemic sclerosis. J Rheumatol 1997;24:81-5.
24) Chang B, Wigley FM, White B, Wise RA. Scleroderma patients with combined pulmonary hypertension and interstitial lung disease. J Rheumatol 2003;30:2398-405.
25) Trad S, Amoura Z, Beigelman C, Haroche J, Costedoat N, Boutin le TH, et al. Pulmonary arterial hypertension is a major mortality factor in diffuse systemic sclerosis, independent of interstitial lung disease. Arthritis Rheum 2006;54:184-91.
26) Ferri C, Giuggioli D, Sebastiani M, Colaci M, Emdin M. Heart involvement and systemic sclerosis. Lupus 2005;14:702-7.
27) British Cardiac Society Guidelines and Medical Practice Committee, and approved by the British Thoracic Society and the British Society of Rheumatology. Recommendations on the management of pulmonary hypertension in clinical practice. Heart 2001;86 Suppl 1:I1-13.