Session Information
Session Title: Systemic Sclerosis, Fibrosing Syndromes and Raynaud's - Clinical Aspects and Therapeutics: Systemic Sclerosis Measures and Outcomes
Session Type: Abstract Submissions (ACR)
Background/Purpose
Cardiac involvement in systemic sclerosis (SSc) adversely affects long-term prognosis, remaining undetectable despite frequent echocardiographic monitoring. Speckle tracking derived strain of the RV free wall was utilized to detect whether early changes in regional and global contractility are detectable in SSc patients in comparison to standard 2D measures of RV chamber size and function.
Methods
138 SSc patients who had technically adequate, clinically indicated 2D echocardiograms were studied, and compared with a cohort of 40 age-matched non-scleroderma controls (C). Conventional 2D and off-line strain analyses were performed. Standard assessment of RV chamber size and function by 2D included linear dimensions of RV base and length, tricuspid annular plane systolic excursion (TAPSE), and RV fractional area change (FAC). RV longitudinal systolic speckle-derived strain (RVLSS) was assessed in the basal, mid and apical free wall. Conventional echo parameters, global RVLSS, and RVLSS in each RV segment were compared between SSc and C by the Student’s t test. We also modeled RVLSS as a function of RV segment and disease group (SSc vs C) using GEE analysis to account for the clustering of RV strain values across the 3 RV segments.
Results
Most conventional echo measures of RV size and function were not different between SSc patients and C, including TAPSE (SSc 2.2 ± 0.47 vs C 2.3 ± 0.4 cm; p=0.119), linear dimensions of the RV base (SSc 3.6 ± 0.6 vs C 3.4 ± 0.4 cm, p=0.066) and RV length (SSc 7.7 ± 0.9 vs C 7.7 ± 0.7 cm, p=0.832). While within the normal range, FAC in SSc patients was slightly decreased (48.9 ± 10.9% vs 52.7 ± 8.0, p=0.045). In contrast to these conventional parameters, measures of RVLSS were significantly different between SSc and C. Global RVLSS was diminished in SSc compared to C (b 1.5, p=0.045). Regional differences in RVLSS were also noted: decreased in the apex (SSc -8.5 vs C -17.2%, p<0.0001) and mid (SSc -12.4 vs C -17.8%, p<0.0001) segments and increased in the base (SSc -32.2 vs C -22.5%, p<0.0001) in SSc vs C. Among C, regional differences in RVLSS were detected in the basal segment relative to the apex (base-apex b -5.4; p<0.0001) but not in the mid-apex comparison. In contrast, SSc had significant regional differences throughout (base-apex b -23.6, mid-apex b -3.9, both p<0.0001), especially when comparing the basal to apical segments. The base-apex difference was significantly greater in SSc compared to C (p<0.0001 for interaction). While SSc had a higher mean PASP than C (SSc 31.4 vs C 22.7 mmHg, p=0.0001), the differences observed in regional strain between SSc and C were unchanged when restricting our analyses to those with a PASP<35 mmHg.
Conclusion
Speckle-derived strain reveals a heterogenous pattern of regional longitudinal systolic contraction in scleroderma, that is not detected by conventional echocardiographic measures. These data suggest that significant RV myocardial disease is occult in SSc patients, and may potentially progress with time.
Disclosure:
M. Mukherjee,
None;
S. E. Chung,
None;
L. K. Hummers,
None;
F. M. Wigley,
Novartis Pharmaceutical Corporation,
5,
Kinemed,
2,
Medimmune,
2,
Sanofi-Aventis Pharmaceutical,
2,
United Therapeutics,
5,
CSL Behring,
2;
T. P. Abraham,
None;
A. A. Shah,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/abnormal-right-ventricular-longitudinal-strain-detected-in-systemic-sclerosis-patients-prior-to-abnormalities-in-conventional-measures-of-right-ventricular-size-and-function/