The role of ultrasound examination for cardiovascular involvement in systemic sclerosis

Laura Poantă, Daniela Fodor, Adriana Albu, Simona Rednic

Abstract


Background: Recent findings indicate that symptomatic heart disease in patients with systemic sclerosis (SSc) predicts poor prognosis, but cardiac involvement may occur years before clinical manifestation. Also, the pathogenesis of SSc includes vascular involvement, with endothelial dysfunction, which can precede clinical atherosclerosis. The aim of this study was to evaluate the cardiovascular function in patients with SSc.

Methods: Thirty consecutive patients with SSc were investigated with transthoracic echocardiography (TTE) and Doppler vascular ultrasound. Two dimensional, pulsed Doppler techniques were to asses the systolic and diastolic function for left ventricle (LV). Endothelial dysfunction was assessed using endothelium-dependent, flow-mediated dilatation (FMD), as well as endothelium-independent, nitroglycerin-mediated dilatation (NMD) of the brachial artery.

Results: None of the patients had any clinical signs of cardiac involvement, nor ECG or TTE systolic function impairment; there are significant differences between systemic sclerosis patients and control group for peak A velocity (0.72 ± 0.19 vs 0.56 ± 0.29, P=0.05) and E/A ratio (1.16 ± 0.22 vs 1.51 ± 0.26, P = 0.01) which account for filling impairment of LV. There is also a significant difference between SSc patients and control group only for FMD, which was significantly lower (4.79 ± 3.54%, vs 8.12 ± 3.21%, P <0.001).

Conclusions: The analysis of SSc heart and vascular disease, mainly at a preclinical level, is important in all the cases due to the fact that an asymptomatic patient may have diastolic dysfunction and endothelial dysfunction which can be treated and should be closer observed.


Keywords


cardiovascular function; ultrasound; systemic sclerosis

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