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De Luca G, Matucci-Cerinic M, Mavrogeni SI. Diagnosis and management of primary heart involvement in systemic sclerosis. Curr Opin Rheumatol 2024; 36:76-93. [PMID: 37962165 DOI: 10.1097/bor.0000000000000990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
PURPOSE OF REVIEW In systemic sclerosis (SSc) primary heart involvement (pHI) is frequent, even though often unrecognized due to its occult nature and to the lack of a specific diagnostic algorithm. The purpose of this review is to report the state of the art of the evidence in the current literature, as well as the overall diagnostic modalities and therapeutic strategies for primary heart involvement in SSc. RECENT FINDINGS SSc-pHI is defined by the presence of cardiac abnormalities that are predominantly attributable to SSc rather than other causes and/or complications; it may be sub-clinical and must be confirmed through diagnostic investigations. Novel electrocardiographic analysis and cardiac magnetic resonance (CMR) with mapping techniques have been recently proposed, showing a great utility in the early identification of SSc-pHI and in the noninvasive characterization of myocardial tissue. Immunosuppressive therapy emerged as fundamental to curb myocardial inflammation, and recent preclinical and clinical data support the role of antifibrotic drugs to treat SSc-pHI. SUMMARY our review will help clinicians to properly integrate the available diagnostic modalities for the assessment of SSc-pHI. The ultimate goal is to propose a feasible diagnostic algorithm for the early identification of patients with SSc-pHI, and a schematic therapeutic approach to manage SSc-pHI.
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Affiliation(s)
- Giacomo De Luca
- Vita-Salute San Raffaele University
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan
| | - Marco Matucci-Cerinic
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sophie I Mavrogeni
- Onassis Cardiac Surgery Center
- University Research Institute of Maternal and Child Health and Precision Medicine and UNESCO Chair in Adolescent Healthcare, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
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Wan M, Yu J, Liu Y, Wang Y, Qiu Y, Yi C, He W, Yang X, Guo Q, Liu D. Left ventricular strain and myocardial work in short-term peritoneal dialysis patients. Ren Fail 2023; 45:2284838. [PMID: 38017695 PMCID: PMC11001367 DOI: 10.1080/0886022x.2023.2284838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Initiation of dialysis encompasses new cardiovascular challenges on patients with end-stage renal disease (ESRD). This study used two-dimensional speckle-tracking echocardiography (2D-STE) to investigate the change of left ventricular (LV) myocardial function undergoing peritoneal dialysis (PD) within 1-3 months. METHODS A total of 56 patients with ESRD and 27 healthy controls were enrolled in this prospective study. Mean duration of PD was 44.41 ± 16.44 days. We evaluated LV myocardial function of patients with ESRD in baseline and within 1-3 months after PD by 2D-STE with global longitudinal strains (GLS) and myocardial work (MW). Based on the level of serum phosphate before PD, patients were divided into two groups: the group with normal serum phosphate or hyperphosphatemia. RESULTS Compared with healthy controls, patients with ESRD had impaired GLS (p < .001) and increased global work index (GWI) (p = .034), global constructive work (GCW) (p < .001), global wasted work (GWW) (p < .001), and lower global work efficiency (GWE) (p = .002). After PD therapy, GWI (p = .001), GCW (p < .001), and GWW (p = .023) decreased and closed to healthy subjects (p > .05) and no significant improvement was observed in GLS (p = .387). GLS of basal segments worsened in the hyperphosphatemia group (p = .005) and GWW reduced remarkably in the group with normal serum phosphate after PD treatment (p = .008). The change of left ventricular internal diameter in diastole (LVIDd) was the only parameter influenced GWI in post-dialysis patients (β = 0.324, p = .013). CONCLUSIONS Short-term PD treatment improved LV MW in ESRD patients. They benefited more when receiving treatment before the increase of serum phosphorus.
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Affiliation(s)
- Minjie Wan
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jianwen Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Yanqiu Liu
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yan Wang
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yagui Qiu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Wei He
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Qunying Guo
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Donghong Liu
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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He W, Li J, Zhang P, Wan M, Xie P, Liang L, Liu D. Non-invasive left ventricular myocardial work identifies subclinical myocardial involvement in patients with systemic lupus erythematosus. Int J Cardiol 2023; 381:145-152. [PMID: 37028712 DOI: 10.1016/j.ijcard.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/16/2023] [Accepted: 04/03/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE Global myocardial work (MW) is a novel indicator that accounts for deformation and afterload, which may provide additional value for assessment of myocardial function. Non-invasive echocardiographic estimated left ventricular (LV) MW incorporates longitudinal strain curves and blood pressure data. This study sought to assess MW in systemic lupus erythematosus (SLE) patients with normal LV ejection fraction (LVEF) by two-dimensional speckle-tracking imaging (2D-STI) to reflect subclinical myocardial damage. METHODS 98 SLE patients and 98 gender and age-matched healthy subjects were included. The patients with SLE were divided into mild activity (SLE disease activity index (SLEDAI) ≤ 4; n = 45), moderate activity (5 ≤ SLEDAI≤9; n = 23), and high activity (SLEDAI≥10; n = 30) subgroups. Standard transthoracic echocardiography was applied to evaluate the systolic myocardial function of the global LV. The parameters of non-invasive MW including global wasted work (GWW) and global work efficiency (GWE) were calculated from echocardiographic LV pressure-strain loops (PSL) and blood pressure at rest. RESULTS The SLE group had a significantly higher GWW (75.7 ± 39.1 mmHg% vs 37.9 ± 18.0 mmHg%, P < 0.001) and decreased GWE ratio (95.5 ± 2.0% vs 97.4 ± 1.0%, P < 0.001) compared with the controls. Among the subgroups with elevating level of disease activity, SLE patients with preserved LVEF had a significantly higher GWW (61.6 ± 29.9 mmHg% to 96.2 ± 42.2 mmHg%, P for trend = 0.001) and markedly decreased GWE (96.4 ± 1.5% to 94.4 ± 2.0%, P for trend = 0.001). In two separate multiple linear regression analyses, SLEDAI were independently associated with GWW (β = 0.271, P = 0.005) and GWE (β = -0.354, P<0.001). CONCLUSION GWW and GWE are promising novel tools for the early detection of subclinical LV dysfunction. GWW and GWE could distinguish distinct patterns in different grades of SLEDAI.
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Affiliation(s)
- Wei He
- Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jie Li
- Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Pengyuan Zhang
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Minjie Wan
- Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Peihan Xie
- Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liuqin Liang
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
| | - Donghong Liu
- Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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Qiao W, Bi W, Wang X, Li Y, Ren W, Xiao Y. Cardiac involvement assessment in systemic sclerosis using speckle tracking echocardiography: a systematic review and meta-analysis. BMJ Open 2023; 13:e063364. [PMID: 36797018 PMCID: PMC9936294 DOI: 10.1136/bmjopen-2022-063364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 02/05/2023] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVES Cardiac involvement in patients with systemic sclerosis (SSc) is associated with poor prognosis. Early detection of myocardial impairment is essential for treatment. The present study aimed to systematically review the value of detecting subclinical myocardial impairment in SSc patients using myocardial strain obtained from speckle tracking echocardiography (STE). DESIGN A systematic review and meta-analysis. DATA SOURCES The PubMed, Embase and Cochrane library databases were searched in the period from the earliest available indexing date to 30 September 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies evaluating myocardial function in SSc patients comparison with healthy controls based on myocardial strain data obtained from STE were included. DATA EXTRACTION AND SYNTHESIS Ventricle and atrium data on myocardial strain were extracted to assessing the mean difference (MD). RESULTS A total of 31 studies were included in the analysis. Left ventricular global longitudinal strain (MD: -2.31, 95% CI -2.85 to -1.76), left ventricular global circumferential strain (MD: -2.93, 95% CI -4.02 to -1.84) and left ventricular global radial strain (MD: -3.80, 95% CI -5.83 to -1.77) was significantly lower in SSc patients than in healthy controls. Right ventricular global wall strain (MD: -2.75, 95% CI -3.25 to -2.25) was also decreased in SSc patients. STE revealed significant differences in several atrial parameters including left atrial reservoir strain (MD: -6.72, 95% CI -10.09 to -3.34) and left atrial conduit strain (MD: -3.26, 95% CI -6.50 to -0.03), as well as right atrial reservoir strain (MD: -7.37, 95% CI -11.20 to -3.53) and right atrial conduit strain (MD: -5.44, 95% CI -9.15 to -1.73). There were no differences in left atrial contractile strain (MD: -1.51, 95% CI -5.34 to 2.33). CONCLUSION SSc patients have a lower strain than healthy controls for the majority of STE parameters, indicating the presence of an impaired myocardium involving both the ventricle and atrium.
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Affiliation(s)
- Wei Qiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wenjing Bi
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xin Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ying Li
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Weidong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yangjie Xiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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Wan M, Liu D, Zhang P, Xie P, Liang L, He W. Postsystolic shortening and early systolic lengthening for early detection of myocardial involvement in patients with systemic lupus erythematosus. Echocardiography 2022; 39:1284-1290. [PMID: 36074004 DOI: 10.1111/echo.15442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/29/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Cardiac involvement predicts a poor prognosis in patients with systemic lupus erythematosus (SLE). Two-dimensional speckle-tracking echocardiography (2D-STE) are used to identify subclinical myocardial involvement in various diseases. This study objected to evaluate postsystolic shortening (PSS) and early systolic lengthening (ESL) by 2D-STE for early detection of myocardial involvement in patients with SLE. METHODS A total of 121 patients with preserved left ventricular ejection fraction (LVEF) in SLE and 30 healthy controls underwent standard 2D-STE in our study. According to SLE disease activity index (SLEDAI), we divided SLE patients into two groups: the group of inactive disease (SLEDAI ≤ 4) and active disease (SLEDAI ≥ 5). The maximum of postsystolic strain index (PSImax ) and early systolic strain index (ESImax ) were acquired from 17 segments of left ventricular (LV). We also compared the PSImax and ESImax of basal, medial, and apical segments between SLE patients and controls. RESULTS Compared with healthy controls and the group of SLEDAI ≤ 4, the group of SLEDAI ≥ 5 had higher PSImax and ESImax value of global LV and basal segments. The absolute value of global longitudinal strain (GLS) had no difference between the group of active disease and inactive disease. Multivariate analysis demonstrated that PSS was independently associated with SLEDAI and diabetes mellitus. CONCLUSIONS Detection of PSS and ESL enable to identify LV systolic impairment in SLE patients at an early stage.
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Affiliation(s)
- Minjie Wan
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Donghong Liu
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Pengyuan Zhang
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Peihan Xie
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Liuqin Liang
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wei He
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Yamasaki S, Miyake M, Sakamoto J, Tamura A, Yamagami S, Nisiuchi S, Yamane K, Tamaki Y, Enomoto S, Kondo H, Tamura T. A case of systemic sclerosis with worsened subclinical left ventricular systolic dysfunction after pacemaker implantation. J Cardiol Cases 2022; 26:134-138. [PMID: 35949580 PMCID: PMC9352417 DOI: 10.1016/j.jccase.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/17/2022] [Accepted: 03/26/2022] [Indexed: 11/29/2022] Open
Abstract
A 58-year-old man suffering from systemic sclerosis was admitted to our hospital because of heart failure. He developed atrioventricular block 4 months previously and had a pacemaker implanted, after which left ventricular wall motion markedly worsened. The global longitudinal strain was already decreased before the onset of atrioventricular block, although the left ventricular ejection fraction was normal. Right ventricular pacing was suspected to have caused overt left ventricular systolic dysfunction. Therefore, right ventricular pacing was upgraded to cardiac resynchronization therapy. After this change, the left ventricular ejection fraction improved to almost normal, but global longitudinal strain remained decreased. The findings in our case suggest that some patients with systemic sclerosis already have subclinical left ventricular systolic dysfunction before the onset of atrioventricular block. Additionally, right ventricular pacing may cause further deterioration of left ventricular systolic function and heart failure. Learning objective The possibility of subclinical left ventricular systolic dysfunction associated with systemic sclerosis should be considered when implanting a pacemaker. Speckle-tracking echocardiography may also be useful in the management of patients with systemic sclerosis.
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Diagnosis of Simultaneous Atrial and Ventricular Mechanical Performance in Patients with Systemic Sclerosis. BIOLOGY 2022; 11:biology11020305. [PMID: 35205171 PMCID: PMC8869228 DOI: 10.3390/biology11020305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/25/2021] [Accepted: 12/30/2021] [Indexed: 11/17/2022]
Abstract
Simple Summary Systemic Sclerosis (SSc) is a chronic connective tissue disorder with an inflammatory and autoimmune nature. The disease presents with microvascular changes, endothelial cell dysfunction, and fibrosis in visceral organs and tissues including lung, skin and heart. Cardiac involvement is a predictor of poor prognosis in this disease; therefore, early and pre-clinical diagnosis of cardiac involvement can be helpful in management of SSc. Two-dimensional Speckle Tracking Echocardiography (2D-STE) is a new method for the evaluation of myocardial strain in longitudinal, circumferential and radial planes. This study aimed at evaluating the mechanical performance of all cardiac chambers by using 2D-STE in patients with scleroderma, and its comparison with normal individuals. This study demonstrated that using 2D-STE can result in the diagnosis of impaired chamber mechanics and function in subclinical stages. Based on our findings, the simultaneous evaluation of all cardiac chambers by 2D-STE provides valuable information regarding myocardial involvement in patients with SSc. Abstract Objective: Cardiac involvement is a predictor of poor prognosis in patients with systemic sclerosis (SSc); therefore, preclinical diagnosis of heart involvement is crucial. Two-dimensional speckle tracking echocardiography (2D-STE), a method for evaluating the myocardial strain, could be helpful for the early diagnosis of cardiac mechanical function abnormalities. In this study, the simultaneous evaluation of all cardiac chambers was studied in patients with SSc, compared with normal individuals. Methods: The results of transthoracic echocardiography (TTE) and 2D-STE of 37 patients with SSc and 37 healthy individuals and the longitudinal strain (LS) of all chambers was precisely evaluated. The collected data were analyzed using SPSS version 16, and independent-sample t test and Chi-square test were used for comparison between the groups. Results: The mean ± SD of the participants’ age was 45.7 ± 11.54 (range of 17 to 68) years; most of them were women (75.7%). TTE showed higher left atrial (LA) volume (p < 0.001), right atrial (RA) area (p = 0.007), the severity of ventricular dysfunction (p < 0.05) and inferior vena cava diameter (p = 0.005), compared with the control group. Spectral and tissue Doppler echocardiography showed higher systolic pulmonary arterial pressure (sPAP) and mitral A wave velocity, and lower E/A ratio, E’ velocity of left ventricular (LV) septal and lateral wall in the case group (p < 0.05). Color Doppler echocardiography showed a higher frequency of valvular regurgitation in the case group (p < 0.05). The results of 2D-STE showed lower LA roof LS (p < 0.001), LA average LS (p = 0.015), LA global LS (p = 0.028), and LA ejection fraction (LAEF) (p = 0.001), lower mean RA left wall (p = 0.048) and EF (p < 0.001), and higher RV global LS in the case group (p = 0.025). Conclusions: Simultaneous evaluation of all cardiac chambers by 2D-STE provides valuable information about the myocardial involvement in patients with SSc. Therefore, it is suggested to use this method for the early diagnosis of cardiac involvement in such patients.
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Vértes V, Porpáczy A, Nógrádi Á, Tőkés-Füzesi M, Hajdu M, Czirják L, Komócsi A, Faludi R. Galectin-3 and sST2: associations to the echocardiographic markers of the myocardial mechanics in systemic sclerosis - a pilot study. Cardiovasc Ultrasound 2022; 20:1. [PMID: 35042522 PMCID: PMC8764793 DOI: 10.1186/s12947-022-00272-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/05/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Progressive cardiac fibrosis is the central aspect of the myocardial involvement in systemic sclerosis (SSc). We hypothesized that circulating biomarkers of the cardiac fibrosis may be useful in the early diagnosis of the cardiac manifestation in this disease. Thus, we investigated the potential correlations between the levels of galectin-3, soluble suppression of tumorigenicity-2 (sST2) and the echocardiographic markers of the myocardial mechanics in SSc patients. METHODS Forty patients (57.3 ± 13.7 years, 36 female) were investigated. In addition to the conventional echocardiography, tissue Doppler and speckle tracking-derived strain techniques were used to assess the function of both ventricles and atria. To estimate the correlations between galectin-3 and sST2 levels and the echocardiographic variables, partial correlation method was used with age as correcting factor. RESULTS In age adjusted analysis galectin-3 level showed significant correlation with left ventricular global longitudinal strain (r = 0.460, p = 0.005); grade of left ventricular diastolic dysfunction (r = 0.394, p = 0.013); septal e' (r = - 0.369, p = 0.021); septal E/e' (r = 0.380, p = 0.017) and with the grade of mitral regurgitation (r = 0.323, p = 0.048). No significant correlation was found between sST2 levels and the echocardiographic variables. CONCLUSIONS Galectin-3 levels, but not sST2 levels show significant correlation with the parameters of the left ventricular systolic and diastolic function. Galectin-3 may be a useful biomarker for the screening and early diagnosis of SSc patients with cardiac involvement.
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Affiliation(s)
- Vivien Vértes
- grid.9679.10000 0001 0663 9479 Heart Institute, Medical School, University of Pécs, Ifjúság út 13, H-7624 Pécs, Hungary
| | - Adél Porpáczy
- grid.9679.10000 0001 0663 9479 Heart Institute, Medical School, University of Pécs, Ifjúság út 13, H-7624 Pécs, Hungary
| | - Ágnes Nógrádi
- grid.9679.10000 0001 0663 9479 Heart Institute, Medical School, University of Pécs, Ifjúság út 13, H-7624 Pécs, Hungary
| | - Margit Tőkés-Füzesi
- grid.9679.10000 0001 0663 9479Department of Laboratory Medicine, Medical School, University of Pécs, Ifjúság út 13, H-7624 Pécs, Hungary
| | - Máté Hajdu
- grid.9679.10000 0001 0663 9479 Heart Institute, Medical School, University of Pécs, Ifjúság út 13, H-7624 Pécs, Hungary
| | - László Czirják
- grid.9679.10000 0001 0663 9479Department of Rheumatology and Immunology, Medical School, University of Pécs, Akác u. 1, H-7632 Pécs, Hungary
| | - András Komócsi
- grid.9679.10000 0001 0663 9479 Heart Institute, Medical School, University of Pécs, Ifjúság út 13, H-7624 Pécs, Hungary
| | - Réka Faludi
- Heart Institute, Medical School, University of Pécs, Ifjúság út 13, H-7624, Pécs, Hungary.
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Jiang X, Zhang F, Li Y, Ren J, Xu D, Cai R, Yi Z, Li C, Liu T, Zhang X, Yao H, Zhu T, Mu R. Clinical assessment of cardiac impairment favored by two-dimensional speckle tracking echocardiology in patients with systemic sclerosis. Rheumatology (Oxford) 2021; 61:2432-2440. [PMID: 34599809 DOI: 10.1093/rheumatology/keab724] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/01/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cardiac involvement is a major cause of death in systemic sclerosis (SSc), while early detection remains a challenge. OBJECTIVES The purpose of this study was to investigate the prevalence and clinical implications of cardiac impairment in SSc. METHODS 95 consecutive SSc patients (55.6 ± 13.8 years old, 5.3 ± 8.1 years from diagnosis) were included in the study. Patients with heart diseases onset prior to SSc were excluded. All patients underwent two-dimensional speckle-tracking echocardiology (2D-STE) with measuring left and right ventricular global longitudinal strain (GLS/RGLS). Clinical manifestation, laboratory evaluation (CRP, cTnI, antibodies, etc.) and ECG were collected at the same time. Comparisons between the SSc subgroups (lcSSc and dcSSc) were performed using Student's t test, Mann-Whitney U or Fisher's exact test. Binary logistic regression was applied to determine the independent effects of variables in cardiac impairment. RESULTS Early left and right ventricular impairment measured by GLS and RGLS were detected in 22.1% and 24.2% of the SSc patients, respectively. In comparison, only 2.1% showed reduced left ventricular ejection fraction (LVEF). Impaired GLS was mainly observed in the basal and medial segments of anterior, lateral, and posterior left ventricle walls, and more profound in dcSSc. Elevated CRP (OR 3.561 95% CI (1.071-11.839), p< 0.05) was associated with reduced GLS/RGLS. The adoption of GLS/RGLS enhanced the efficacy of routine screening for cardiac impairment that 52.6% of patients showed potential cardiac impairment. CONCLUSIONS Cardiac impairment is a common manifestation in SSc. Increasing awareness of early cardiac impairment is warranted with elevated CRP and dcSSc.
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Affiliation(s)
- Xintong Jiang
- Departments of Rheumatology, and Immunology, People's Hospital, Peking University, Beijing, China
| | - Feng Zhang
- Departments of Cardiology, People's Hospital, Peking University, Beijing, China
| | - Yuhui Li
- Departments of Rheumatology, and Immunology, People's Hospital, Peking University, Beijing, China
| | - Jingyi Ren
- Departments of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Dan Xu
- Departments of Rheumatology, and Immunology, People's Hospital, Peking University, Beijing, China.,Departments of Rheumatology and Immunology, Third Hospital, Peking University, Beijing, China
| | - Ruyi Cai
- Departments of Rheumatology, and Immunology, People's Hospital, Peking University, Beijing, China.,Departments of Rheumatology and Immunology, Third Hospital, Peking University, Beijing, China
| | - Zixi Yi
- Departments of Rheumatology, and Immunology, People's Hospital, Peking University, Beijing, China.,Departments of Rheumatology and Immunology, Third Hospital, Peking University, Beijing, China
| | - Chun Li
- Departments of Rheumatology, and Immunology, People's Hospital, Peking University, Beijing, China
| | - Tian Liu
- Departments of Rheumatology, and Immunology, People's Hospital, Peking University, Beijing, China
| | - Xia Zhang
- Departments of Rheumatology, and Immunology, People's Hospital, Peking University, Beijing, China
| | - Haihong Yao
- Departments of Rheumatology, and Immunology, People's Hospital, Peking University, Beijing, China
| | - Tiangang Zhu
- Departments of Cardiology, People's Hospital, Peking University, Beijing, China
| | - Rong Mu
- Departments of Rheumatology, and Immunology, People's Hospital, Peking University, Beijing, China.,Departments of Rheumatology and Immunology, Third Hospital, Peking University, Beijing, China
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Civieri G, Castaldi B, Martini G, Meneghel A, Milanesi O, Zulian F. Early detection of ventricular dysfunction in juvenile systemic sclerosis by speckle tracking echocardiography. Rheumatology (Oxford) 2021; 60:103-107. [PMID: 32572491 PMCID: PMC7785305 DOI: 10.1093/rheumatology/keaa208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/26/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Cardiac involvement is the most important cause of mortality in juvenile systemic sclerosis (JSSc). Recent reports in adult patients underline that traditional techniques of imaging are inadequate to assess the subclinical cardiac involvement, while speckle tracking echocardiography (STE) is able to identify ventricular dysfunctions in the early stages. The aim of our study was to assess the role of STE in JSSc. METHODS Demographic, clinical and laboratory data were collected from patients with JSSc. Cardiac investigations performed at baseline (T0) and 18 (T18) and 36 months (T36) follow-up included electrocardiography, conventional echocardiography with measurement of the ejection fraction (EF) and STE with assessment of left and right ventricular global longitudinal strain (LV-GLS and RV-GLS). Cardiac parameters have been compared with demographic characteristics and disease severity, assessed by the Juvenile Systemic Sclerosis Severity Score (J4S). RESULTS A total of 18 patients, 12 (67%) females, entered the study. At T0, electrocardiography was abnormal in three patients, EF was reduced in one, LV-GLS was abnormal in three (16.7%) and RV-GLS was abnormal in five (27.8%). At T18, EF remained stable while at T36 the result decreased in seven of nine patients. At the same time, LV-GLS also worsened (from -21.6% to -18.2%, P = 0.01). LV-GLS and RV-GLS at baseline showed a significant correlation with J4S (P = 0.012 and P = 0.02, respectively). CONCLUSION STE is more sensitive than standard echocardiography to identify cardiac involvement in JSSc. Over time, we observed a gradual worsening of LV-GLS, a sign of left ventricular dysfunction, that anticipated by several months the decrease of EF.
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Affiliation(s)
- Giovanni Civieri
- Department of Woman's and Child's Health, University of Padova, Padua, Italy
| | - Biagio Castaldi
- Department of Woman's and Child's Health, University of Padova, Padua, Italy
| | - Giorgia Martini
- Department of Woman's and Child's Health, University of Padova, Padua, Italy
| | - Alessandra Meneghel
- Department of Woman's and Child's Health, University of Padova, Padua, Italy
| | - Ornella Milanesi
- Department of Woman's and Child's Health, University of Padova, Padua, Italy
| | - Francesco Zulian
- Department of Woman's and Child's Health, University of Padova, Padua, Italy
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11
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Mercurio V, Hinze AM, Hummers LK, Wigley FM, Shah AA, Mukherjee M. Essential Hypertension Worsens Left Ventricular Contractility in Systemic Sclerosis. J Rheumatol 2021; 48:1299-1306. [PMID: 33452172 DOI: 10.3899/jrheum.200873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Primary cardiac involvement in systemic sclerosis (SSc) is prevalent and morbid; however, the influence of traditional cardiovascular (CV) risk factors, such as essential hypertension (HTN), are unclear. In the present study, we sought to understand the effects of HTN on left ventricular (LV) contractility in patients with SSc using echocardiographic speckle-derived global longitudinal strain (GLS). METHODS Fifty-six SSc patients with HTN (SSc+HTN+) and 82 SSc patients without HTN (SSc+ HTN-) were compared with 40 non-SSc controls with HTN (SSc-HTN+) and 40 non-SSc controls without HTN (SSc-HTN-), matched by age and sex. All HTN patients were on stable antihypertensive therapies. Echocardiographic measures included LV (LV) ejection fraction (LVEF), left atrial volume index (LAVI), and LV diastolic function. LV contractility was assessed by GLS, averaged across the 18 LV segments. RESULTS Patients with SSc had diminished GLS regardless of HTN status when compared to both control groups, despite normal LVEF (P < 0.001). SSc+HTN+ had the highest prevalence of diastolic dysfunction, with significantly higher septal E/e´, a marker of LV filling pressures (P < 0.05), as well as the largest reduction in GLS compared to SSc+HTN- and both control groups. CONCLUSION Speckle-derived strain revealed diminished LV contractility in patients with SSc, despite normal LVEF. SSc+HTN+ had more prominent reductions in GLS associated with evidence of LV remodeling and worsened diastolic function. Our findings demonstrate the presence of subclinical LV contractile dysfunction in SSc that is further exacerbated by concomitant HTN, thereby identifying HTN as an important modifiable CV risk factor that should be managed aggressively in this at-risk population.
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Affiliation(s)
- Valentina Mercurio
- V. Mercurio, MD, PhD, Assistant Professor of Medicine, University of Naples Federico II, Department of Translational Medical Sciences, and Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine
| | - Alicia M Hinze
- A.M. Hinze, MD, Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Laura K Hummers
- L.K. Hummers, MD, ScM, Associate Professor of Medicine, Clinical Director, F.M. Wigley, MD, Martha McCrory Professor of Medicine, Director, A.A. Shah, MD, MHS, Associate Professor of Medicine, Director, Clinical and Translational Research, Johns Hopkins Scleroderma Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine
| | - Fredrick M Wigley
- L.K. Hummers, MD, ScM, Associate Professor of Medicine, Clinical Director, F.M. Wigley, MD, Martha McCrory Professor of Medicine, Director, A.A. Shah, MD, MHS, Associate Professor of Medicine, Director, Clinical and Translational Research, Johns Hopkins Scleroderma Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine
| | - Ami A Shah
- L.K. Hummers, MD, ScM, Associate Professor of Medicine, Clinical Director, F.M. Wigley, MD, Martha McCrory Professor of Medicine, Director, A.A. Shah, MD, MHS, Associate Professor of Medicine, Director, Clinical and Translational Research, Johns Hopkins Scleroderma Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine
| | - Monica Mukherjee
- M. Mukherjee, MD, MPH, Associate Professor of Medicine, Medical Director, Johns Hopkins Bayview Echocardiography, Director, Johns Hopkins Echocardiography Research, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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12
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Calabrò P, Cesaro A. Cardiac involvement in systemic sclerosis: 'early diagnosis-early management' approach. Eur J Prev Cardiol 2020; 27:1873-1875. [PMID: 32312106 DOI: 10.1177/2047487320919235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Italy.,Division of Clinical Cardiology, A.O.R.N. 'Sant'Anna e San Sebastiano', Italy
| | - Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Italy.,Division of Clinical Cardiology, A.O.R.N. 'Sant'Anna e San Sebastiano', Italy
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13
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Lo Gullo A, Rodríguez-Carrio J, Gallizzi R, Imbalzano E, Squadrito G, Mandraffino G. Speckle tracking echocardiography as a new diagnostic tool for an assessment of cardiovascular disease in rheumatic patients. Prog Cardiovasc Dis 2020; 63:327-340. [PMID: 32201285 DOI: 10.1016/j.pcad.2020.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/08/2020] [Indexed: 12/30/2022]
Abstract
Chronic inflammation represents the cornerstone of the raised cardiovascular (CV) risk in patients with inflammatory rheumatic diseases (IRD). Standardized mortality ratios are increased in these patients compared to the general population, which can be explained by premature mortality associated with early atherosclerotic events. Thus, IRD patients need appropriate CV risk management in view of this CV disease (CVD) burden. Currently, optimal CV risk management is still lacking in usual care, and early diagnosis of silent and subclinical CVD involvement is mandatory to improve the long-term prognosis of those patients. Although CV involvement in such patients is highly heterogeneous and may affect various structures of the heart, it can now be diagnosed earlier and promptly treated. CV imaging provides valuable information as a reliable diagnostic tool. Currently, different techniques are employed to evaluate CV risk, including transthoracic or trans-esophageal echocardiography, magnetic resonance imaging, or computed tomography, to investigate valve abnormalities, pericardial disease, and ventricular wall motion defects. All the above methods are reliable in investigating CV involvement, but more recently, Speckle Tracking Echocardiography (STE) has been suggested to be diagnostically more accurate. In recent years, the role of left ventricular ejection fraction (LVEF) as the gold standard parameter for the evaluation of systolic function has been debated, and many efforts have been focused on the clinical validation of new non-invasive tools for the study of myocardial contractility as well as to characterize the subclinical alterations of the myocardial function. Improvement in the accuracy of STE has resulted in a large amount of research showing the ability of STE to overcome LVEF limitations in the majority of primary and secondary heart diseases. This review summarizes the additional value that STE measurement can provide in the setting of IRD, with a focus in the different clinical stages.
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Affiliation(s)
- Alberto Lo Gullo
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, 98122, Italy; IRCCS Neurolesi Bonino-Pulejo, Piemonte Hospital, 98100, Italy
| | - Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, Faculty of Medicine, University of Oviedo, Oviedo 33006, Spain; Instituto de Investigación Sanitaria Del Principado de Asturias (ISPA), Oviedo 33011, Spain; Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación Nefrológica, REDinREN Del ISCIII, Hospital Universitario Central de Asturias, Oviedo 33011, Spain.
| | - Romina Gallizzi
- Unit of Pediatrics, Department of Human Pathology in Adulthood and Childhood, University of Messina, 98122
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, 98122, Italy
| | - Giovanni Squadrito
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, 98122, Italy
| | - Giuseppe Mandraffino
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, 98122, Italy
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Hajsadeghi S, Mirshafiee S, Pazoki M, Moradians V, Mansouri P, Kianmehr N, Iranpour A. The relationship between global longitudinal strain and pulmonary function tests in patients with scleroderma and normal ejection fraction and pulmonary artery pressure: a case-control study. Int J Cardiovasc Imaging 2020; 36:883-888. [PMID: 32060775 DOI: 10.1007/s10554-020-01788-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 01/31/2020] [Indexed: 11/25/2022]
Abstract
This study examined the relationship between global longitudinal strain (GLS) and pulmonary function tests (PFT) in patients with systemic sclerosis (SS) and normal ejection fraction (EF) and pulmonary artery pressure (PAP) and healthy controls. Sixty patients in two groups underwent extensive screening, including echocardiography, physical examination, the modified Rodnan Skin Score, and pulmonary function tests. Pulmonary interstitial disease was diagnosed by the pulmonary function test and by CT scan in case of indication. GLS score was computed as the mean peak systolic strain for 17 segments. The mean GLS score was - 18.36 ± 2.1 in the case group and - 20.66 ± 1.6 in the control group (P value < 0.001). GLS scores had a significant inverse relationship with the forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) ratio (P value = 0.049) and both FEV and FVC in patients younger than 35 years old (P = 0.046 and 0.049, respectively). GLS scores had no significant relationship with time elapsed since the onset of skin manifestations, and Raynaud phenomenon, Rodnan score, EF, systolic PAP, or the six-minute walk test results. The patients' six-minute walk test had a significant positive relationship with FVC and right ventricular end diastolic diameter (P value = 0.018 and 0.047, respectively). According to our findings, GLS is significantly lower in patients with SS (with normal EF & PAP) than in healthy individuals. It is also related with certain pulmonary function indices including FEV1/FVC. The reduction in GLS is associated with reduced pulmonary function strength.
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MESH Headings
- Adult
- Arterial Pressure
- Case-Control Studies
- Exercise Tolerance
- Female
- Forced Expiratory Volume
- Humans
- Lung/blood supply
- Lung/physiopathology
- Lung Diseases, Interstitial/diagnosis
- Lung Diseases, Interstitial/etiology
- Lung Diseases, Interstitial/physiopathology
- Male
- Middle Aged
- Myocardial Contraction
- Prognosis
- Pulmonary Arterial Hypertension/diagnosis
- Pulmonary Arterial Hypertension/etiology
- Pulmonary Arterial Hypertension/physiopathology
- Pulmonary Artery/physiopathology
- Risk Factors
- Scleroderma, Systemic/complications
- Scleroderma, Systemic/diagnosis
- Scleroderma, Systemic/physiopathology
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left
- Ventricular Function, Right
- Vital Capacity
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Affiliation(s)
- Shokoufeh Hajsadeghi
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology & Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mahboubeh Pazoki
- Department of Cardiovascular Disease, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Vahan Moradians
- Pulmonology Department, Hazrat-e-Rasoul Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Pejman Mansouri
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Nahid Kianmehr
- Internal Medicine Department, Iran University of Medical Sciences, Tehran, Iran
| | - Aida Iranpour
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology & Metabolism, Iran University of Medical Sciences, Tehran, Iran
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15
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Left Ventricular Deformation in Patients with Connective Tissue Disease: Evaluated by 3.0T Cardiac Magnetic Resonance Tissue Tracking. Sci Rep 2019; 9:17913. [PMID: 31784546 PMCID: PMC6884516 DOI: 10.1038/s41598-019-54094-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/08/2019] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to assess left ventricular (LV) myocardial strain in patients with connective tissue disease (CTD) and compare LV deformation between subgroups of idiopathic inflammatory myopathy (IIM) and non-IIM. Ninety-eight patients with CTD, comprising 56 with IIM and 42 with non-IIM, and 30 healthy subjects were enrolled and underwent 3.0T cardiac magnetic resonance imaging (MRI) scanning. The LV function and strain parameters were measured and assessed. Our result revealed that CTD patients had preserved LV ejection fraction (60.85%) and had significantly decreased global and regional peak strain (PS) in radial, circumferential, and longitudinal directions (all p < 0.05). IIM patients showed significantly reduced global longitudinal PS (GLPS) and longitudinal PS at apical slice, whereas all strain parameters decreased in non-IIM patients. Except GLPS and longitudinal PS at apical slice, all strain parameters in non-IIM patients were lower than those in IIM patients. By Pearson’s correlation analysis, the LV global radial and circumferential PS were correlated to N-terminal pro-brain natriuretic peptide level and LV ejection fraction in both IIM and non-IIM patients. This study indicated that CTD patients showed abnormal LV deformation despite with preserved LVEF. The impairment of LV deformation differed between IIM and non-IIM patients.
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16
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CMR feature tracking in cardiac asymptomatic systemic sclerosis: Clinical implications. PLoS One 2019; 14:e0221021. [PMID: 31433819 PMCID: PMC6703686 DOI: 10.1371/journal.pone.0221021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 07/30/2019] [Indexed: 01/29/2023] Open
Abstract
Background Impaired myocardial deformation has been sporadically described in cardiac asymptomatic systemic sclerosis (SSc). We aimed to study myocardial deformation indices in cardiac asymptomatic SSc patients using cardiac magnetic resonance feature tracking (CMR-FT) and correlate these findings to the phenotypic and autoimmune background. Methods Fifty-four cardiac asymptomatic SSc patients (44 females, 56±13 years), with normal routine cardiac assessment and CMR evaluation, including cine and late gadolinium enhancement (LGE) images, were included. SSc patients were compared to 21 sex- and age- matched healthy controls (17 females; 54±19 years). For CMR-FT analysis, a mid-ventricular slice for LV peak systolic radial and circumferential strain and a 4-chamber view for LV/RV peak systolic longitudinal strain were used. Results Twenty-four patients had diffuse cutaneous SSc and 30 limited cutaneous SSc. Thirteen patients had digital ulcers. Median disease duration was 3.6 years. LV ejection fraction was higher in SSc patients compared to controls (62±6% vs. 59±5%, p = 0.01). Four patients had no LGE examination; in the remaining patients LGE was absent in 74%, while 18% had RV insertion fibrosis and 8% evidence of subendocardial infarction. LV longitudinal strain differed in those with insertion fibrosis (-18.0%) and infarction (-16.7%) compared to no fibrosis (-20.3%, p = 0.04). Patients with SSc had lower RV longitudinal strain and strain rate compared to controls (p<0.001 and p = 0.01, respectively). All other strain and strain rate measurements were non-significant between patients and controls. Conclusions In cardiac asymptomatic SSc patients with normal routine functional indices, CMR-FT identifies subclinical presence of insertion fibrosis and/or myocardial infarction by impaired LV longitudinal strain. RV derived longitudinal indices were impaired in the patient group. CMR FT indices did not correlate to the patients’ phenotypic and autoimmune features.
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Aboughanima AT, Gomaa A, El Olemy G. Asymptomatic left ventricular diastolic dysfunction in diffuse systemic sclerosis patients: conventional echocardiography and left atrial speckle tracking. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2019. [DOI: 10.4103/err.err_15_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Tennøe AH, Murbræch K, Andreassen JC, Fretheim H, Midtvedt Ø, Garen T, Dalen H, Gude E, Andreassen A, Aakhus S, Molberg Ø, Hoffmann-Vold AM. Systolic Dysfunction in Systemic Sclerosis: Prevalence and Prognostic Implications. ACR Open Rheumatol 2019; 1:258-266. [PMID: 31777802 PMCID: PMC6857986 DOI: 10.1002/acr2.1037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objective Primary cardiac involvement is presumed to account for a substantial part of disease-related mortality in systemic sclerosis (SSc). Still, there are knowledge gaps on the evolution and total burden of systolic dysfunction in SSc. Here we evaluated prospective left ventricular (LV) and right ventricular (RV) systolic function in an unselected SSc cohort and assessed the burden of systolic dysfunction on mortality. Methods From the Oslo University Hospital cohort, 277 SSc patients were included from 2003-2016 and compared with healthy controls. Serial echocardiographies were reevaluated in order to detect change in systolic function. Right heart catheterization was performed on patients suspected of pulmonary hypertension. Descriptive and regression analyses were conducted. Results At baseline, LV systolic dysfunction by ejection fraction less than 50%, or a global longitudinal strain greater than -17.0%, was found in 12% and 24%, respectively. RV systolic dysfunction measured by tricuspid annular plane systolic excursion (TAPSE) less than 17 mm was evident in 10%. Follow-up echocardiography was performed after a median of 3.3 years (interquartile range [IQR] 1.5-5.6). At follow-up, LV systolic function remained stable, whereas RV function evaluated by TAPSE deteriorated (mean 23.1 to 21.7 mm, P = 0.005) equaling a 15% prevalence of RV systolic dysfunction. RV systolic function predicted mortality in multivariable models (hazard ratio 0.41, 95% confidence interval [CI] 0.19-0.90, P value 0.027), whereas LV systolic function lost predictive significance when adjusted for TAPSE. Conclusion In this unselected and prospective study, systolic dysfunction of the LV and RV was a frequent complication of SSc. LV systolic function remained stable across the observation period, whereas RV function deteriorated and predicted mortality.
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Affiliation(s)
- Anders H Tennøe
- Oslo University Hospital, Oslo, Norway and University of Oslo Oslo Norway
| | | | | | - Håvard Fretheim
- Oslo University Hospital, Oslo, Norway and University of Oslo Oslo Norway
| | | | | | - Håvard Dalen
- Norwegian University of Science and Technology, Trondheim, Norway and Clinic of Cardiology, St. Olav's Hospital, Trondheim, Norway, and Levanger Hospital, Nord-Trøndelag Hospital Trust Levanger Norway
| | | | | | - Svend Aakhus
- Norwegian University of Science and Technology, Trondheim, Norway and Clinic of Cardiology, St. Olav's Hospital Trondheim Norway
| | - Øyvind Molberg
- Oslo University Hospital, Oslo, Norway and University of Oslo Oslo Norway
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Karadag DT, Sahin T, Tekeoglu S, Işik OO, Yazici A, Eraldemir FC, Cefle A. Evaluation of left and right ventricle by two-dimensional speckle tracking echocardiography in systemic sclerosis patients without overt cardiac disease. Clin Rheumatol 2019; 39:37-48. [PMID: 31127462 DOI: 10.1007/s10067-019-04604-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/09/2019] [Accepted: 05/12/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND/OBJECTIVE The aim was to evaluate the left and right ventricular functions concurrently by two-dimensional speckle tracking echocardiography (STE) in systemic sclerosis (SSc) patients without overt cardiac disease. METHODS A total of 47 patients with SSc and 36 age- and sex-matched controls were evaluated cross-sectionally. Two-dimensional STE was used to assess the longitudinal peak systolic strains (PSS) of both ventricles including apical long-axis (APLAX), apical four-chamber (4-CH), apical two-chamber (2-CH), and global longitudinal measurements. Any association of metabolic, cardiac, and inflammatory biomarkers with PSS was investigated. RESULTS The longitudinal PSS of the left ventricle [APLAX, 4-CH, 2-CH and global] were significantly lower in SSc patients than controls (- 18.2 ± 3.2 vs - 19.8 ± 2.7% p = 0.02; - 17.8 ± 3.5 vs. - 20.3 ± 3.3% p = 0.001; - 18.6 ± 3.1 vs. - 21.8 ± 3% p < 0.001; - 17.5 ± 5.7 vs. - 20.6 ± 2.7% p = 0.003, respectively). No difference was found between the groups for right ventricular strains. The longitudinal PSS-4CH correlated positively with CRP and ESR (r = 0.349, p = 0.016; r = 0.356, p = 0.014, respectively) and negatively with serum Galectin-3 (r = - 0.362, p = 0.012). Global longitudinal PSS-left ventricle (LV) correlated positively with CRP and homocysteine (r = 0.297, p = 0.043; r = 0.313, p = 0.041, respectively) and negatively with serum Galectin-3 (r = -0.314, p = 0.041). After multivariable adjustment, CRP remained the only predictor of longitudinal PSS-4CH (95% CI 0.35, 0.70, p = 0.028) and global longitudinal PSS of left ventricle (95% CI 0.004, 0.22, p = 0.043). CONCLUSIONS Biventricular evaluation of patients with SSc by two dimensional STE revealed reduced left ventricular longitudinal strains, despite preserved right ventricular strain, and no diastolic dysfunction. In SSc without overt cardiac disease, global cardiac assessment with 2DSTE is a promising method which seems to contribute to the detection of patients without clinical findings. KEY POINTS • Two dimensional STE revealed reduced left ventricular longitudinal strains, despite preserved right ventricular strain in SSc patients without overt cardiac disease. • CRP was the predictor of decreased longitudinal strains. • Cardiac assessment in SSc should be made globally.
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Affiliation(s)
- Duygu Temiz Karadag
- Division of Rheumatology, Department of Internal Medicine, Kocaeli University School of Medicine, Kocaeli, Turkey.
| | - Tayfun Sahin
- Division of Cardiology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Senem Tekeoglu
- Division of Rheumatology, Department of Internal Medicine, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Ozlem Ozdemir Işik
- Division of Rheumatology, Department of Internal Medicine, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Ayten Yazici
- Division of Rheumatology, Department of Internal Medicine, Kocaeli University School of Medicine, Kocaeli, Turkey
| | | | - Ayse Cefle
- Division of Rheumatology, Department of Internal Medicine, Kocaeli University School of Medicine, Kocaeli, Turkey
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Yaman M, Arslan U, Bayramoglu A, Bektas O, Gunaydin ZY, Kaya A. The presence of fragmented QRS is associated with increased epicardial adipose tissue and subclinical myocardial dysfunction in healthy individuals. Rev Port Cardiol 2019; 37:469-475. [PMID: 29776809 DOI: 10.1016/j.repc.2017.09.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 08/01/2017] [Accepted: 09/02/2017] [Indexed: 02/06/2023] Open
Abstract
AIM The aim of this study was to measure epicardial adipose tissue (EAT) and to assess left ventricular (LV) systolic and diastolic function in a healthy population grouped according to the presence of fragmented QRS (fQRS). METHODS In this prospective case-control study, the study population consisted of 308 healthy individuals who were divided into two groups according to the existence of fQRS: 180 fQRS(+) individuals (with fQRS), and 128 age- and gender-matched fQRS(-) individuals (without fQRS). These individuals were assessed for EAT thickness and subclinical myocardial dysfunction using transthoracic echocardiography including strain imaging. RESULTS The baseline clinical characteristics were similar between groups. EAT thickness was significantly increased in fQRS(+) individuals (0.59 vs. 0.44 mm, p<0.001). LV global longitudinal strain, reflecting systolic function (19.62±3.05 vs. 20.95±2.36, p<0.001) and E/A ratio, reflecting diastolic function (0.95±0.30 vs. 1.10±0.37, p<0.001), were decreased, revealing subclinical myocardial dysfunction, in fQRS(+) individuals. CONCLUSIONS The presence of fQRS on the admission ECG is associated with increased EAT and pronounced subclinical LV systolic and diastolic dysfunction in a healthy population. Further studies with larger patient groups are needed to clarify the exact pathophysiological mechanisms underlying these findings in healthy populations.
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Affiliation(s)
- Mehmet Yaman
- University of Health Sciences, Samsun Training and Research Hospital, Samsun, Turkey; Ordu University, Education and Research Hospital, Cardiology Department, Ordu, Turkey.
| | - Ugur Arslan
- University of Health Sciences, Samsun Training and Research Hospital, Samsun, Turkey
| | - Adil Bayramoglu
- Ordu University, Education and Research Hospital, Cardiology Department, Ordu, Turkey
| | - Osman Bektas
- Ordu University, Education and Research Hospital, Cardiology Department, Ordu, Turkey
| | - Zeki Yuksel Gunaydin
- Ordu University, Education and Research Hospital, Cardiology Department, Ordu, Turkey
| | - Ahmet Kaya
- Ordu University, Education and Research Hospital, Cardiology Department, Ordu, Turkey
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Lindholm A, Hesselstrand R, Rådegran G, Arheden H, Ostenfeld E. Decreased biventricular longitudinal strain in patients with systemic sclerosis is mainly caused by pulmonary hypertension and not by systemic sclerosis per se. Clin Physiol Funct Imaging 2019; 39:215-225. [PMID: 30597705 PMCID: PMC6850088 DOI: 10.1111/cpf.12561] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/28/2018] [Indexed: 02/06/2023]
Abstract
Purpose Patients with pulmonary arterial hypertension (PAH) due to systemic sclerosis (SSc) have high mortality. Left ventricular (LV) peak global longitudinal strain (GLS) is decreased in SSc. It is unknown whether low GLS is due to SSc or PAH. Therefore, our primary aim was to evaluate both LV and right ventricular free wall GLS (RVFW GLS) in SSc, with and without PAH, using cardiac magnetic resonance with feature tracking. Secondary aim was to relate GLS to invasive mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR). Methods Thirty‐eight patients with SSc, 19 patients with SSc‐PAH and 19 healthy controls for comparison, were included. Endocardial and epicardial borders were delineated in cine images (short‐axis stack and three long‐axis views) for volumetric and strain calculations. Results Systemic sclerosis‐PAH had lower LV and RVFW GLS than SSc (LV: P = 0·01, RV: P<0·001) and controls (LV: P = 0·02; RV: P<0·001), with no difference between SSc and controls. LV strain correlated with mPAP (R = 0·42, P = 0·03) and PVR (R = 0·52, P = 0·006). RVFW GLS correlated with mPAP (R = 0·68, P<0·001) and PVR (R = 0·59, P = 0·001). ROC curves for predicting PAH had AUC 0·73 for LV strain (P = 0·003) and 0·86 for RVFW GLS (P<0·001). Conclusions Lower GLS is mainly determined by increased pulmonary pressure and not by SSc per se. Low LV and RVFW GLS are indicative of increased mPAP and PVR, which opens for improved non‐invasive methods to select patients eligible for right heart catheterization and to monitor the effects of PAH therapy.
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Affiliation(s)
- Anthony Lindholm
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Roger Hesselstrand
- Department of Clinical Sciences Lund, Rheumatology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Göran Rådegran
- Department of Clinical Sciences Lund, Cardiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ellen Ostenfeld
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund University, Lund, Sweden
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Ten Years of 2D Longitudinal Strain for Early Myocardial Dysfunction Detection: A Clinical Overview. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8979407. [PMID: 30627581 PMCID: PMC6304576 DOI: 10.1155/2018/8979407] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/05/2018] [Accepted: 10/30/2018] [Indexed: 12/30/2022]
Abstract
In recent years, the role of left ventricular ejection fraction (EF) as the gold standard parameter for the evaluation of systolic function has been questioned, and many efforts have been concentrated in the clinical validation of new noninvasive tools for the study of myocardial contractility. Improvement in the accuracy of speckle-tracking echocardiography has resulted in a large amount of research showing the ability of two-dimensional strain to overcome EF limitations in the majority of primary and secondary heart diseases. Currently, global longitudinal strain (GLS) is considered the most accurate and sensitive parameter for the assessment of early left ventricular dysfunction. This review summarizes the advantages that this measurement can provide in several clinical settings. Moreover, the important cautions that should be considered in making the choice to use GLS also are addressed. Finally, a special focus on bull's-eye polar maps for the assessment of regional changes of longitudinal function and the usefulness of these maps in the differential diagnosis of several diseases is provided.
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El Razaky O, El Amrousy D, Elrifaey S, Elgendy M, Ibrahim W. Three-dimensional speckle tracking echocardiography: Is it the magic wand in the diagnosis of subclinical myocardial dysfunction in children with type 1 diabetes mellitus? Echocardiography 2018; 35:1657-1663. [PMID: 29981180 DOI: 10.1111/echo.14095] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To revaluate the role of three-dimensional speckle tracking echocardiography (3D-STE) in the evaluation of subclinical myocardial dysfunction in asymptomatic children with type 1 diabetes mellitus (DM). PATIENTS AND METHODS Fifty asymptomatic children with type 1 DM were included as a patient group. Fifty healthy children of matched age, sex, and weight served as a control group. Laboratory investigations in the form of complete blood count (CBC), liver function test, renal function test, complete blood lipid profile, glycosylated hemoglobin (HbA1c), fasting and 2 hours postprandial (PP) glucose levels, and cardiac troponin I (cTnT I) were drawn. Complete echocardiographic evaluation of the left ventricular (LV) function was performed in the form of conventional echo, 2D strain, tissue Doppler imaging (TDI), and 3D- STE. RESULTS cTnT I levels were significantly higher in the patient group than the control group, and this increase was significantly correlated with Hb A1c. Conventional echocardiography showed normal systolic and diastolic function of the LV. Diastolic (by TDI) as well as systolic functions of LV (by 4D LV quantification tool) were found to be significantly lower in patient group than control group. 3D-STE examination showed that there was a significant decrease in all component of strain in patient group than control group and that decrease correlated well with 4D LV EF but did not correlate with the duration of DM. There was a significant negative correlation between longitudinal strain and the control of DM. CONCLUSION 3D-STE is a good tool for prediction of early cardiac dysfunction in asymptomatic children with type 1 DM.
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Affiliation(s)
- Osama El Razaky
- Pediatric Department, Tanta University Hospital, Tanta, Egypt
| | - Doaa El Amrousy
- Pediatric Department, Tanta University Hospital, Tanta, Egypt
| | | | - Marwa Elgendy
- Pediatric Department, Tanta University Hospital, Tanta, Egypt
| | - Wesam Ibrahim
- Clinical Pathology Department, Tanta University Hospital, Tanta, Egypt
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24
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Guerra F, Stronati G, Fischietti C, Ferrarini A, Zuliani L, Pomponio G, Capucci A, Danieli MG, Gabrielli A. Global longitudinal strain measured by speckle tracking identifies subclinical heart involvement in patients with systemic sclerosis. Eur J Prev Cardiol 2018; 25:1598-1606. [PMID: 29966435 DOI: 10.1177/2047487318786315] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Systemic sclerosis is characterised by progressive cutaneous and organ fibrosis. Among all organs, a subclinical heart involvement is difficult to detect through conventional imaging. Design We evaluated whether speckle tracking-derived global longitudinal strain could help detect early subclinical systolic dysfunction in systemic sclerosis patients without overt clinical involvement. Methods A case-control, single-centre study on 52 systemic sclerosis patients and 52 age and gender-matched controls. Patients with structural heart disease, heart failure, atrial fibrillation and pulmonary hypertension were excluded. For every patient, standard echocardiographic and speckle tracking-derived variables for the systolic and diastolic function of the left ventricle and right ventricle were acquired. Results Traditional parameters of left and right systolic function did not differ between systemic sclerosis patients and controls (all P = ns). Left and right ventricular global longitudinal strain was significantly impaired in patients with systemic sclerosis when compared to controls (-19.2% vs. -21.1%; P = 0.009 and -18.2% vs. -22.3%; P = 0.012, respectively). Systemic sclerosis patients had a 2.5-fold increased risk of subclinical left ventricular systolic impairment (odds ratio 2.5, 95% confidence interval 1.1-5.5; P = 0.027) and a 3.3-fold increased risk of subclinical right ventricular systolic impairment when compared to controls (odds ratio 3.3, 95% confidence interval 1.4-7.7; P = 0.004). Alterations in the myocardial deformation pattern of systemic sclerosis patients were homogeneous in the right ventricle and eccentric in the left ventricle. Conclusions While traditional echocardiographic parameters are ineffective in detecting subclinical systolic impairment, reduced global longitudinal strain is common in patients with systemic sclerosis and significant for both ventricles. Global longitudinal strain could become a low-cost, non-invasive and reliable tool in order to detect early cardiac involvement in systemic sclerosis patients.
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Affiliation(s)
- Federico Guerra
- 1 Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Italy
| | - Giulia Stronati
- 1 Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Italy
| | | | | | - Lucia Zuliani
- 2 Clinica Medica, Marche Polytechnic University, Italy
| | | | - Alessandro Capucci
- 1 Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Italy
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25
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Yaman M, Arslan U, Bayramoglu A, Bektas O, Gunaydin ZY, Kaya A. The presence of fragmented QRS is associated with increased epicardial adipose tissue and subclinical myocardial dysfunction in healthy individuals. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2017.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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26
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Myocardial function in primary antiphospholipid syndrome using speckle-tracking echocardiography. Clin Rheumatol 2018; 37:3351-3358. [DOI: 10.1007/s10067-018-4088-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 03/24/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
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27
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Tadic M, Zlatanovic M, Cuspidi C, Stevanovic A, Celic V, Damjanov N, Kocijancic V. Systemic sclerosis impacts right heart and cardiac autonomic nervous system. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:188-194. [PMID: 29064088 DOI: 10.1002/jcu.22552] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/22/2017] [Accepted: 09/30/2017] [Indexed: 06/07/2023]
Abstract
AIM To evaluate the influence of systemic sclerosis (SSc) on right ventricular (RV) remodeling by two- and three-dimensional echocardiography (2DE and 3DE) and heart rate variability (HRV). METHODS Forty-five SSc patients and 35 age- and gender-matched healthy controls underwent clinical examination, 24-h Holter monitoring, and comprehensive 2DE and 3DE. RESULTS 2DE RV global and RV free wall longitudinal strains, as well as 2DE RV endocardial, mid-myocardial, and epicardial longitudinal strains were lower in SSc subjects, who exhibited greater 3DE RV volumes but lower 3DE RV ejection fraction than controls. HRV indices were impaired in SSc subjects. These differences in RV global and free wall longitudinal strain, layer-specific strains, and ejection fraction, were associated with HRV indices independently of demographic, clinical, and echocardiographic parameters. Modified Rodnan Skin Score, clinical indicator of skin involvement in SSc, was associated with HRV parameters, RV layer-specific mechanics, and RV ejection fraction. CONCLUSION SSc affects RV function and mechanics of all myocardial layers, as well as cardiac autonomic nervous function. HRV indices are significantly associated with RV function, RV deformation, and skin involvement in SSc patients.
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Affiliation(s)
- Marijana Tadic
- Cardiology Department, University Clinical Hospital Center "Dr. Dragisa Misovic-Dedinje,", Heroja Milana Tepica 1, Belgrade 11000, Serbia
| | - Maja Zlatanovic
- Institute for Rheumatology, Resavska 69, Belgrade 11000, Serbia
| | - Cesare Cuspidi
- Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Viale della Resistenza 23, Meda 20036, Italy
| | - Ana Stevanovic
- Cardiology Department, University Clinical Hospital Center "Dr. Dragisa Misovic-Dedinje,", Heroja Milana Tepica 1, Belgrade 11000, Serbia
| | - Vera Celic
- Cardiology Department, University Clinical Hospital Center "Dr. Dragisa Misovic-Dedinje,", Heroja Milana Tepica 1, Belgrade 11000, Serbia
| | | | - Vesna Kocijancic
- Cardiology Department, University Clinical Hospital Center "Dr. Dragisa Misovic-Dedinje,", Heroja Milana Tepica 1, Belgrade 11000, Serbia
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28
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Bournia VK, Tountas C, Protogerou AD, Panopoulos S, Mavrogeni S, Sfikakis PP. Update on assessment and management of primary cardiac involvement in systemic sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2018; 3:53-65. [PMID: 35382127 PMCID: PMC8892878 DOI: 10.1177/2397198317747441] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2017] [Indexed: 09/26/2023]
Abstract
Primary cardiac involvement is a common and severe complication of systemic sclerosis, which may affect all of the hearts' structural components, including pericardium, myocardium, endocardium, cardiac valves, and conduction system. While cardiac disease can be clinically silent and only diagnosed in autopsy, new imaging modalities such as speckle-tracking echocardiography and cardiovascular magnetic resonance may reveal various abnormal findings in the majority of patients. Cardiovascular magnetic resonance evaluation should include assessment of left and right ventricular function, inflammation (STIR T2-weighted sequences (T2-W) for edema detection), and fibrosis (T1-weighted sequences 15 min after Gd-DTPA contrast medium injection (late-gadolinium enhancement). Notably, cardiac disease is responsible for about one-fourth of systemic sclerosis-related deaths. Systematic studies for the assessment and therapy of systemic sclerosis-related cardiac complications, as well as relevant guidelines from the European League Against Rheumatism and the American College of Rheumatology, are currently lacking. However, research advances reviewed herein allow for a better understanding of the mechanisms that alter cardiac function. Implementation of such knowledge should reduce cardiac morbidity and mortality in systemic sclerosis patients.
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Affiliation(s)
- Vasiliki-Kalliopi Bournia
- First Department of Propaedeutic
and Internal Medicine and Joined Rheumatology Program, Medical School,
National and Kapodistrian University of Athens, Laikon Hospital, Athens -
Greece
| | - Christos Tountas
- First Department of Propaedeutic
and Internal Medicine and Joined Rheumatology Program, Medical School,
National and Kapodistrian University of Athens, Laikon Hospital, Athens -
Greece
| | - Athanase D. Protogerou
- Cardiovascular Prevention and
Research Unit, Department of Pathophysiology, Medical School, National and
Kapodistrian University of Athens, Athens - Greece
| | - Stylianos Panopoulos
- First Department of Propaedeutic
and Internal Medicine and Joined Rheumatology Program, Medical School,
National and Kapodistrian University of Athens, Laikon Hospital, Athens -
Greece
| | | | - Petros P. Sfikakis
- First Department of Propaedeutic
and Internal Medicine and Joined Rheumatology Program, Medical School,
National and Kapodistrian University of Athens, Laikon Hospital, Athens -
Greece
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29
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Dedeoglu R, Adroviç A, Oztunç F, Sahin S, Barut K, Kasapcopur O. New Insights into Cardiac Involvement in Juvenile Scleroderma: A Three-Dimensional Echocardiographic Assessment Unveils Subclinical Ventricle Dysfunction. Pediatr Cardiol 2017; 38:1686-1695. [PMID: 28913656 DOI: 10.1007/s00246-017-1714-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 08/29/2017] [Indexed: 12/21/2022]
Abstract
Cardiac manifestations in juvenile scleroderma or systemic sclerosis (JSSc) have poor prognosis, begin in early stages of the disease, and remain clinically asymptomatic. New echocardiography modalities, such as 2D/3D speckle tracking (STE, strain analysis for regional and global ventricular functions), can detect cardiac involvement in early stages. We assessed 21 JSSc patients and 19 controls using 2D/3D STE. The left ventricular end diastolic volume, end systolic volume, and ejection fraction of the patient and control groups were significantly different (99.2 ± 23.8 vs. 52 ± 23.8, 40.6 ± 16.0 vs. 20.2 ± 17.4 and 59.2 ± 7.5 vs. 65.6 ± 5.2, respectively). Global longitudinal strain (GLS) and global circumferential strain (GCS) were lower in the patient group (18.4 ± 4.7 vs. 22.4 ± 3.7, 26.4 ± 5.8 vs. 31.4 ± 3.5), as were the peak systolic strain values of the right ventricular longitudinal strain (RVLS) septum and RVLS free wall (18.1 ± 6.8 vs. 24.8 ± 6.0 and 22.8 ± 5.9 vs. 28.0 ± 6.9, respectively). 3D measurements of RVEDV, RVESV, and RVSV were higher in the patient group (88.2 ± 31.3 vs. 50.8 ± 23.5, 43.1 ± 17.6 vs. 19.0 ± 12.2, and 45.0 ± 16.2 vs. 31.7 ± 12.6). RVLS freewall results were lower in the JSSc patients with interstitial lung fibrosis, arthritis, muscle weakness, weight loss, and anti-scl 70 antibodies than in the JSSc patients without these variables. We found that a GCS of <34.5% could identify patients for left ventricular (LV) dysfunction with a sensitivity of 93.3, specificity of 92.9, while an RVEF of <60.7% could identify patients for left ventricular (RV) dysfunction with a sensitivity of 92.9 and specificity of 21.4%. We highlighted key advantages of 3D STE for the tracking of early systolic dysfunction in patients with JSSc who would benefit from medical intervention for cardiac complications.
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Affiliation(s)
- Reyhan Dedeoglu
- Department of Pediatric Cardiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
| | - Amra Adroviç
- Department of Pediatric Rheumatology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Funda Oztunç
- Department of Pediatric Cardiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Sezgin Sahin
- Department of Pediatric Rheumatology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Kenan Barut
- Department of Pediatric Rheumatology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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30
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Hromádka M, Seidlerová J, Suchý D, Rajdl D, Lhotský J, Ludvík J, Rokyta R, Baxa J. Myocardial fibrosis detected by magnetic resonance in systemic sclerosis patients – Relationship with biochemical and echocardiography parameters. Int J Cardiol 2017; 249:448-453. [DOI: 10.1016/j.ijcard.2017.08.072] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 07/13/2017] [Accepted: 08/29/2017] [Indexed: 01/06/2023]
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31
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Saito M, Wright L, Negishi K, Dwyer N, Marwick TH. Mechanics and prognostic value of left and right ventricular dysfunction in patients with systemic sclerosis. Eur Heart J Cardiovasc Imaging 2017; 19:660-667. [DOI: 10.1093/ehjci/jex147] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 06/04/2017] [Indexed: 01/06/2023] Open
Affiliation(s)
- Makoto Saito
- Menzies Institute for Medical Research, 17 Liverpool St, University of Tasmania, Hobart TAS 7000, Australia
| | - Leah Wright
- Menzies Institute for Medical Research, 17 Liverpool St, University of Tasmania, Hobart TAS 7000, Australia
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - Kazuaki Negishi
- Menzies Institute for Medical Research, 17 Liverpool St, University of Tasmania, Hobart TAS 7000, Australia
| | - Nathan Dwyer
- Royal Hobart Hospital, 48 Liverpool St Hobart TAS 7000, Australia
| | - Thomas H Marwick
- Menzies Institute for Medical Research, 17 Liverpool St, University of Tasmania, Hobart TAS 7000, Australia
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
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32
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Tadic M, Zlatanovic M, Cuspidi C, Ivanovic B, Stevanovic A, Damjanov N, Kocijancic V, Celic V. The relationship between left ventricular deformation and heart rate variability in patients with systemic sclerosis: Two- and three-dimensional strain analysis. Int J Cardiol 2017; 236:145-150. [DOI: 10.1016/j.ijcard.2017.02.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 01/26/2017] [Accepted: 02/10/2017] [Indexed: 12/11/2022]
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33
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Gunasekaran P, Panaich S, Briasoulis A, Cardozo S, Afonso L. Incremental Value of Two Dimensional Speckle Tracking Echocardiography in the Functional Assessment and Characterization of Subclinical Left Ventricular Dysfunction. Curr Cardiol Rev 2017; 13:32-40. [PMID: 27411342 PMCID: PMC5324318 DOI: 10.2174/1573403x12666160712095938] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 06/26/2016] [Accepted: 06/29/2016] [Indexed: 02/01/2023] Open
Abstract
Subclinical left ventricular (LV) dysfunction refers to subtle abnormalities in LV function which typically precede a reduction in the left ventricular ejection fraction (LVEF). The assessment of myocardial function using LVEF, a radial metric of systolic function, is subject to load dependence, intra-observer and inter-observer variability. Reductions in LVEF typically manifest late in the disease process thus compromising the ability to intervene before irreversible impairment of systolic performance sets in. 2-Dimensional speckle tracking echocardiography (2D-STE), a novel strain imaging modality has shown promise as a sensitive indicator of myocardial contractility. It arms the clinician with a powerful and practical tool to rapidly quantify cardiac mechanics, circumventing several inherent limitations of conventional echocardiography. This article highlights the incremental utility of 2D-STE in the detection of subclinical LV dysfunction.
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Affiliation(s)
| | | | | | | | - Luis Afonso
- Division of Cardiology, Wayne State University, Detroit Medical Center, 3990 John R, 8-Brush, Harper University Hospital, Detroit, Michigan-48201. United States
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Mavrogeni S, Markousis-Mavrogenis G, Koutsogeorgopoulou L, Dimitroulas T, Bratis K, Kitas GD, Sfikakis P, Tektonidou M, Karabela G, Stavropoulos E, Katsifis G, Boki KA, Kitsiou A, Filaditaki V, Gialafos E, Plastiras S, Vartela V, Kolovou G. Cardiovascular magnetic resonance imaging pattern at the time of diagnosis of treatment naïve patients with connective tissue diseases. Int J Cardiol 2017; 236:151-156. [PMID: 28185705 DOI: 10.1016/j.ijcard.2017.01.104] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 01/17/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND-AIM Cardiac involvement at diagnosis of connective tissue disease (CTD) has been described by echocardiography. We hypothesized that cardio-vascular magnetic resonance (CMR) detects occult lesions at CTD diagnosis. PATIENTS-METHODS CMR was performed early after diagnosis in 78 treatment-naïve CTDs (aged 43±11, 59F/19M) without cardiac involvement [5 Takayasu arteritis (TA), 4 Churg Strauss syndrome (CSS), 5 Wegener granulomatosis (WG), 16 systemic lupus erythematosus (SLE), 12 rheumatoid arthritis (RA), 8 mixed connective tissue diseases (MCTD), 12 ankylosing spondylitis (AS), 3 polymyalgia rheumatica (PMR), 8 systemic sclerosis (SSc) and 5 dermatomyositis (DM)]. Acute and chronic lesions were assessed by T2>2 with positive LGE and T2<2 with positive LGE, respectively. RESULTS In 3/5 TA, 3/4 CSS, 4/5 WG, 10/16 SLE, 9/12 RA, 6/8 MCTD, 4/12 AS, 1/3 PMR, 2/8 SSc and 2/5 DM, the T2 ratio was higher compared to normal (2.78±0.25 vs 1.5±0.2, p<0.01). Myocarditis was identified in 1 TA, 1 SLE, 1 RA, 1 SSc and 2 DM patients; diffuse, subendocardial fibrosis in 1 CSS and 1 RA patient, while subendocardial myocardial infarction in 3 SLE, 1 MCTD, 1 PMR and 2 RA patients. CMR re-evaluation after 6 and 12months of rheumatic and cardiac treatment, available in 28/52 CTDs with increased T2 ratio, showed significant improvement in T2 ratio (p<0.001), non-significant change in LGE extent and normalisation of those with impaired LV function. CONCLUSIONS Occult CMR lesions, including oedema, myocarditis, diffuse subendocardial fibrosis and myocardial infarction are not unusual in treatment naïve CTDs and may be reversed with appropriate treatment.
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Affiliation(s)
| | | | | | - Theodoros Dimitroulas
- Department of Rheumatology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - George D Kitas
- Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK
| | - Petros Sfikakis
- Joint Academic Rheumatology Program, National and Kapodistrian University of Athens Medical School, Greece
| | - Maria Tektonidou
- Joint Academic Rheumatology Program, National and Kapodistrian University of Athens Medical School, Greece
| | | | | | | | | | | | | | - Elias Gialafos
- Joint Academic Rheumatology Program, National and Kapodistrian University of Athens Medical School, Greece
| | - Sotiris Plastiras
- Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece
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Cardiac mechanics and heart rate variability in patients with systemic sclerosis: the association that we should not miss. Rheumatol Int 2016; 37:49-57. [PMID: 27888320 DOI: 10.1007/s00296-016-3618-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/18/2016] [Indexed: 10/20/2022]
Abstract
We aimed to determine left ventricular (LV) and right ventricular (RV) structure, function and mechanics, as well as heart rate variability (HRV), and their relationship, in patients with systemic sclerosis (SSc). The study included 41 SSc patients and 30 age-matched healthy volunteers. All the patients underwent clinical examination, serological tests, pulmonary function testing, 24-h Holter monitoring and complete two-dimensional echocardiography including strain analysis. The parameters of LV structure (interventricular septum thickness and LV mass index) and RV structure (RV wall thickness) were significantly higher in SSc patients. LV and RV diastolic function (estimated by mitral and tricuspid E/e' ratio) was significantly impaired in SSc group comparing with the healthy controls. LV and RV longitudinal function was significantly deteriorated in SSc patients. LV circumferential strain was also significantly lower in SSc group, whereas LV radial strain was similar between the observed groups. All parameters of time and frequency domain of HRV were decreased in SSc patients. LV and RV cardiac remodeling parameters, particularly diastolic function and longitudinal strain, were associated with HRV indices without regard to the main demographic or the clinical and echocardiographic characteristics. Rodnan Skin Score was also independently associated with biventricular cardiac remodeling in SSc patients. LV and RV structure, function and mechanics, as well as autonomic nervous function, were significantly impaired in SSc patients. There is the significant association between biventricular cardiac remodeling and autonomic function in these patients, which could be useful for their everyday clinical assessment.
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36
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Claus P, Omar AMS, Pedrizzetti G, Sengupta PP, Nagel E. Tissue Tracking Technology for Assessing Cardiac Mechanics: Principles, Normal Values, and Clinical Applications. JACC Cardiovasc Imaging 2016; 8:1444-1460. [PMID: 26699113 DOI: 10.1016/j.jcmg.2015.11.001] [Citation(s) in RCA: 302] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/06/2015] [Indexed: 02/06/2023]
Abstract
Tissue tracking technologies such as speckle tracking echocardiography and feature tracking cardiac magnetic resonance have enhanced the noninvasive assessment of myocardial deformation in clinical research and clinical practice. The widespread enthusiasm for using tissue tracking techniques in research and clinical practice stems from the ready applicability of these technologies to routine echocardiographic or cardiac magnetic resonance images. The technology is common to both modalities, and derived parameters to describe myocardial mechanics are the similar, albeit with different accuracies. We provide an overview of the normal values and reproducibility of the clinically applicable parameters, together with their clinical validation. The use of these technologies in different clinical scenarios, and the additive value to current imaging diagnostics are discussed.
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Affiliation(s)
- Piet Claus
- Laboratory for Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Alaa Mabrouk Salem Omar
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Internal Medicine, Medical Division, National Research Centre, Dokki, Cairo, Egypt
| | - Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Partho P Sengupta
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eike Nagel
- Institute of Cardiovascular Imaging, Goethe University Frankfurt and German Centre for Cardiovascular Research ([DZHK], partner site Rhine-Main), Frankfurt, Germany.
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Becker MO, Riemekasten G. Risk factors for severity and manifestations in systemic sclerosis and prediction of disease course. Expert Rev Clin Immunol 2015; 12:115-35. [PMID: 26558747 DOI: 10.1586/1744666x.2016.1115717] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Systemic sclerosis (SSc, or scleroderma) is a rheumatic disease with distinct features that encompass autoimmunity, vascular lesions (vasculopathy) and tissue fibrosis. The disease has a high morbidity and mortality compared with other rheumatic diseases. This review discusses risk factors and markers that predict the disease course and the occurrence of disease manifestations, with an emphasis on major organ involvement. In addition, risk factors will be described that are associated with mortality in SSc patients. The review addresses the impact of recent developments on screening, diagnosis and risk stratification as well as the need for further research where data are lacking.
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Affiliation(s)
- Mike O Becker
- a Department of Rheumatology and Clinical Immunology , University Hospital Charité Berlin , Berlin , Germany
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Schmid J, Kaufmann R, Grübler MR, Verheyen N, Weidemann F, Binder JS. Strain Analysis by Tissue Doppler Imaging: Comparison of Conventional Manual Measurement with a Semiautomated Approach. Echocardiography 2015; 33:372-8. [DOI: 10.1111/echo.13100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Johannes Schmid
- Division of Cardiology; Department of Internal Medicine; Medical University of Graz; Graz Austria
- Division of General Radiology; Department of Radiology; Medical University of Graz; Graz Austria
| | - Reinhard Kaufmann
- Division of Cardiology; Department of Internal Medicine; Medical University of Graz; Graz Austria
| | - Martin R. Grübler
- Division of Cardiology; Department of Internal Medicine; Medical University of Graz; Graz Austria
| | - Nicolas Verheyen
- Division of Cardiology; Department of Internal Medicine; Medical University of Graz; Graz Austria
| | - Frank Weidemann
- Department of Cardiology; Katharinen-Hospital Unna; Unna Germany
- Comprehensive Heart Failure Center; Würzburg Germany
| | - Josepha S. Binder
- Division of Cardiology; Department of Internal Medicine; Medical University of Graz; Graz Austria
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Sunbul M, Bozbay M, Mammadov C, Cincin A, Atas H, Ozsenel EB, Sari I, Basaran Y. Effect of vitamin D deficiency and supplementation on myocardial deformation parameters and epicardial fat thickness in patients free of cardiovascular risk. Int J Cardiovasc Imaging 2015; 31:765-72. [DOI: 10.1007/s10554-015-0622-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 02/16/2015] [Indexed: 01/02/2023]
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40
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Contractile reserve in systemic sclerosis patients as a major predictor of global cardiac impairment and exercise tolerance. Int J Cardiovasc Imaging 2014; 31:529-36. [DOI: 10.1007/s10554-014-0583-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 12/22/2014] [Indexed: 10/24/2022]
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Tigen K, Sunbul M, Ozen G, Durmus E, Kivrak T, Cincin A, Ozben B, Atas H, Direskeneli H, Basaran Y. Regional myocardial dysfunction assessed by two-dimensional speckle tracking echocardiography in systemic sclerosis patients with fragmented QRS complexes. J Electrocardiol 2014; 47:677-83. [DOI: 10.1016/j.jelectrocard.2014.07.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Indexed: 01/16/2023]
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Agoston G, Gargani L, Miglioranza MH, Caputo M, Badano LP, Moreo A, Muraru D, Mondillo S, Moggi Pignone A, Matucci Cerinic M, Sicari R, Picano E, Varga A. Left atrial dysfunction detected by speckle tracking in patients with systemic sclerosis. Cardiovasc Ultrasound 2014; 12:30. [PMID: 25090937 PMCID: PMC4134332 DOI: 10.1186/1476-7120-12-30] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac involvement is a relevant clinical finding in systemic sclerosis (SSc) and is associated with poor prognosis. Left atrial (LA) remodeling and/or dysfunction can be an early sign of diastolic dysfunction. Two-dimensional speckle tracking echocardiography (STE) is a novel and promising tool for detecting very early changes in LA myocardial performance. AIM To assess whether STE strain parameters may detect early alterations in LA function in SSc patients. METHODS Forty-two SSc patients (Group 1, age 50 ± 14 years, 95% females) without clinical evidence for cardiac involvement and 42 age- and gender-matched control subjects (Group 2, age 49 ± 13 years, 95% females) were evaluated with comprehensive 2D and Doppler echocardiography, including tissue Doppler imaging analysis. Positive peak left atrial longitudinal strain (ϵ pos peak), second positive left atrial longitudinal strain (sec ϵ pos peak), and negative left atrial longitudinal strain (ϵ neg peak) were measured using a 12-segment model for the LA, by commercially available semi-automated 2D speckle-tracking software (EchoPac PC version 108.1.4, GE Healthcare, Horten, Norway). RESULTS All SSc patients had a normal left ventricular ejection fraction (63.1 ± 4%). SSc patients did not differ from controls in E/A (Group 1 = 1.1 ± 0.4 vs Group 2 = 1.3 ± 0.4, p = .14) or pulmonary arterial systolic pressure (Group 1 = 24.1 ± 8 mmHg vs Group 2 = 21 ± 7 mmHg, p = .17). SSc patients did not show significantly different indexed LA volumes (Group 1 = 24.9 ± 5.3 ml/m2 vs Group 2 = 24.7 ± 4.4 ml/m2, p = .8), whereas E/e' ratio was significantly higher in SSc (Group 1 = 7.6 ± 2.4 vs Group 2 = 6.5 ± 1.7, p<0.05), although still within normal values. LA strain values were significantly different between the two groups (ϵ pos peak Group 1 = 31.3 ± 4.2% vs Group 2 = 35.0 ± 7.6%, p < .01, sec ϵ pos peak Group 1 = 18.4 ± 4 vs Group 2 = 21.4 ± 7.6, p < 0.05). CONCLUSION 2D speckle-tracking echocardiography is a sensitive tool to assess impairment of LA mechanics, which is detectable in absence of changes in LA size and volume, and may represent an early sign of cardiac involvement in patients with SSc.
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Affiliation(s)
- Gergely Agoston
- 2nd Department of Medicine and Cardiology Center, University of Szeged, Korányi Fasor 6, 6720 Szeged, Hungary
| | - Luna Gargani
- Institute of Clinical Physiology, National Council of Research, Pisa, Italy
| | - Marcelo Haertel Miglioranza
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
- Cardiology Institute of Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Caputo
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - Luigi Paolo Badano
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Antonella Moreo
- Cardiology Department, Niguarda Ca’ Granda Hospital, Milan, Italy
| | - Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Sergio Mondillo
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | | | - Marco Matucci Cerinic
- Department of Biomedicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Rosa Sicari
- Institute of Clinical Physiology, National Council of Research, Pisa, Italy
| | - Eugenio Picano
- Institute of Clinical Physiology, National Council of Research, Pisa, Italy
| | - Albert Varga
- 2nd Department of Medicine and Cardiology Center, University of Szeged, Korányi Fasor 6, 6720 Szeged, Hungary
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Sano M, Satoh H, Suwa K, Nobuhara M, Saitoh T, Saotome M, Urushida T, Katoh H, Shimoyama K, Suzuki D, Ogawa N, Takehara Y, Sakahara H, Hayashi H. Characteristics and clinical relevance of late gadolinium enhancement in cardiac magnetic resonance in patients with systemic sclerosis. Heart Vessels 2014; 30:779-88. [PMID: 24996373 PMCID: PMC4648959 DOI: 10.1007/s00380-014-0539-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 06/13/2014] [Indexed: 01/14/2023]
Abstract
Cardiac involvement in systemic sclerosis (SSc) is considerably frequent in autopsy, but the early identification is clinically difficult. Recent advantages in cardiac magnetic resonance (CMR) enabled to detect myocardial fibrotic scar as late gadolinium enhancement (LGE). We aimed to examine the prevalence and distribution of LGE in patients with SSc, and associate them with clinical features, electrocardiographic abnormalities and cardiac function. Forty patients with SSc (58 ± 14 years-old, 35 females, limited/diffuse 25/15, disease duration 106 ± 113 months) underwent serological tests, 12-lead electrocardiogram (ECG) and CMR. Seven patients (17.5 %) showed LGE in 26 segments of left ventricle (LV). LGE distributed mainly in the basal to mid inter-ventricular septum and the right ventricular (RV) insertion points, but involved all the myocardial regions. More patients with LGE showed NYHA functional class II and more (71 vs. 21 %, p < 0.05), bundle branch blocks (57 vs. 6 %, p < 0.05), LV ejection fraction (LVEF) < 50 % (72 vs. 6 %, p < 0.01), LV asynergy (43 vs. 0 %, p < 0.01) and RVEF < 40 % (100 vs. 39 %, p < 0.01). There was no difference in disease duration, disease types, or prevalence of positive autoimmune antibodies or high serum NT-proBNP level (>125 pg/ml). When cardiac involvement of SSc was defined as low LVEF, ECG abnormalities or high NT-proBNP, the sensitivity, specificity positive and negative predictive values of LGE were 36, 92, 71 and 72 %, respectively. We could clarify the prevalence and distribution of LGE in Japanese patients with SSc. The presence of LGE was associated with cardiac symptom, conduction disturbance and impaired LV/RV contraction.
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Affiliation(s)
- Makoto Sano
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
| | - Hiroshi Satoh
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan.
| | - Kenichiro Suwa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
| | - Mamoru Nobuhara
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
| | - Takeji Saitoh
- Department of Emergency Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masao Saotome
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
| | - Tsuyoshi Urushida
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
| | - Hideki Katoh
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
| | - Kumiko Shimoyama
- Division of Immunology and Rheumatology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Daisuke Suzuki
- Division of Immunology and Rheumatology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Noriyoshi Ogawa
- Division of Immunology and Rheumatology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasuo Takehara
- Department of Radiology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Harumi Sakahara
- Department of Radiology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideharu Hayashi
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
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Right ventricular and atrial functions in systemic sclerosis patients without pulmonary hypertension. Herz 2014; 40:709-15. [DOI: 10.1007/s00059-014-4113-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 04/18/2014] [Accepted: 04/27/2014] [Indexed: 12/26/2022]
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Spethmann S, Rieper K, Riemekasten G, Borges AC, Schattke S, Burmester GR, Hewing B, Baumann G, Dreger H, Knebel F. Echocardiographic follow-up of patients with systemic sclerosis by 2D speckle tracking echocardiography of the left ventricle. Cardiovasc Ultrasound 2014; 12:13. [PMID: 24678809 PMCID: PMC3986623 DOI: 10.1186/1476-7120-12-13] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 03/21/2014] [Indexed: 11/29/2022] Open
Abstract
Background Subclinical myocardial involvement is common in systemic sclerosis (SSc) and associated with poor prognosis. Early detection, particularly during follow-up, is important. Two-dimensional speckle tracking echocardiography (STE) has already been shown to detect early left ventricular systolic impairment in SSc patients with advanced disease. The aim of this study was to assess the ability of STE to diagnose changes in left ventricular function in patients with SSc with preserved LV ejection fraction (LVEF) and normal pulmonary pressure over time. Methods This single-center pilot study included nineteen SSc patients without pulmonary hypertension and preserved LVEF (55.2 ± 10.8 years, 13 women, mean modified Rodnan Skin Score of 8.2 ± 6.5, median disease duration 6 ± 4.5 years). We performed STE at baseline and after two years (mean 756.6 ± 8.8 days). Pulmonary hypertension was ruled out in all patients by right heart catheterization (average mean PAP 17.7 ± 3.5 mmHg). Results The LVEF remained unchanged (63.3 ± 4.2% vs. 63.2 ± 5.0%, P = ns), but the global longitudinal peak systolic strain of the left ventricle was significantly lower: baseline -22.0 ± 2.3% vs. follow-up -20.8 ± 2.1% (P = 0.04). The regional analysis showed a heterogeneous distribution of segmental systolic dysfunction that did not match any particular coronary artery distribution. In contrast, the LV diastolic function remained stable during follow-up. Conclusion STE might be a sensititive and valuable method to detect early LV systolic impairment in patients with SSc and preserved LVEF during two years. Prospective evaluations are needed for prognostic implications of these changes.
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Affiliation(s)
- Sebastian Spethmann
- Medizinische Klinik für Kardiologie und Angiologie, Campus Mitte, Charité Universitätsmedizin Berlin, Charitéplatz 1, Berlin D-10117, Germany.
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Frerix M, Meier F, Hermann W, Müller-Ladner U. Therapeutische Strategien im Frühstadium der systemischen Sklerose. Z Rheumatol 2013; 72:960-9. [DOI: 10.1007/s00393-013-1270-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Chen S, Yuan J, Qiao S. Authors' reply. Cardiology 2013; 124:260. [PMID: 23571717 DOI: 10.1159/000346919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 12/28/2012] [Indexed: 11/19/2022]
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Cusmà Piccione M, Zito C, Bagnato G, Oreto G, Di Bella G, Bagnato G, Carerj S. Role of 2D strain in the early identification of left ventricular dysfunction and in the risk stratification of systemic sclerosis patients. Cardiovasc Ultrasound 2013; 11:6. [PMID: 23374960 PMCID: PMC3575331 DOI: 10.1186/1476-7120-11-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 01/29/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systemic sclerosis (SSc) is an autoimmune chronic disease characterized by diffuse fibrosis involving several organs, including heart. Aim of our study was to analyze left ventricular (LV) myocardial deformation, by use of 2D strain, in asymptomatic SSc patients with normal LV ejection fraction. METHODS We enrolled 29 SSc patients (28 female, 65±4 years) and 30 controls (23 female, 64±2 years). Echocardiographic study with tissue Doppler imaging (TDI) and 2D strain analysis was performed; moreover, patients were submitted to a two-year follow-up for the occurrence of cardiovascular events. RESULTS Standard echocardiographic parameters and TDI velocities were comparable between groups. LV longitudinal (LS) and circumferential (CS) strains were lower in patients than in controls (-13.1±4.8 vs -22.6±4.1, p < 0.001; -15.3±6.2 vs -20.4±5.6, p = 0.001), whereas radial strain (RS) was comparable between groups; moreover, a significant correlation of LS and CS with serum levels of Scl-70 antibodies was found (r = 0.74, p = 0.001; r = 0.53, p = 0.025). In addition, patients with cardiovascular events during follow-up showed a greater impairment of LS and CS (-10.3±2.5 vs -14.4±4.1, p = 0.015; -14.2±3.1 vs -20.1±1.6, p = 0.048) and higher values of Scl-70 antibodies serum levels (p = 0.047). CONCLUSION The impairment of LV function, often subclinical, worsens prognosis of SSc patients, leading to increased risk of cardiovascular complications. 2D strain, allowing the early detection of LV abnormalities and the identification of patients at greater cardiovascular risk, may be a useful tool in order to provide a more accurate management of SSc patients.
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Affiliation(s)
- Maurizio Cusmà Piccione
- Clinical and Experimental Department of Medicine and Pharmacology - Cardiology, University of Messina, Via Consolare Valeria, A.O.U. Policlinico G. Martino, Messina 98100, Italy.
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