Background/Purpose Primary Sjögren’s syndrome (pSS) is a common chronic autoimmune disease that particularly affects the salivary and lachrymal glands, and leads to dry eyes and dry mouth. We have previously shown that plasma asymmetric dimethylarginine (ADMA) levels and coronary flow reserve (CFR) are impaired in patients with pSS. The aim of this study was to investigate the use of impaired speckle tracking as a marker of subclinical left ventricular dysfunction predicting congestive heart failure in patients with pSS and a normal ejection fraction. 

Methods The study involved 49 outpatients who fulfilled the American-European Consensus Criteria (AECG) criteria for pSS (14 males and 35 females; mean age 57 ±6.9 years), and 22 healthy controls matched in terms of age, gender and other anthropometric characteristics. Cardiovascular (CV) risk profiles were assessed by means of standard electrocardiography (ECG), conventional and stress trans-thoracic echocardography with the measurement of CFR, carotid ultrasonography and pulse wave velocity (PWV). Two-dimensional echocardiographic images were obtained using the apical 4-chamber view at a high frame rate of 70-80 frames/s, and three cardiac cycles were stored in cine-loop format for off-line analysis using commercially available QLAB 9 software (Philips Medical System, USA) in order to assess end-systolic LV longitudinal strain (ε).

Results All of the patients had extra-extraglandular systemic involvement pSS: 30 were being treated with hydroxychloroquine (HCQ) 400 mg/day, 11 with azathioprine (AZA) at a mean dose of 150 mg/day (range 50-200 mg), and eight with methotrexate (MTX) at a mean dose of 7.5 mg/weekly. None of the patients showed any signs or symptoms of CV disease, pulmonary involvement, or any other complication. The patients’ mean EF and E/A ratios were respectively 59.11±6.35% and 0.94±0.0.24, which were not significantly different from those of the controls; however, although within the normal range, their CFR was lower (median 2.7, IQR 2.40-2.90 vs 3.20, IQR 3.06-3.33; p<0.0001). Right and left pulse wave velocity (PWV) (PWV m/sec  median 8.8, IQR 7.26-10.32 vs 6.86, IQR 6.66-7.10; p<0.0001) and right and left coronary intima media thickness (cIMT) (cIMT mm: median 0.6, IQR 0.5-0.7 vs 0.53, IQR 0.50-0.60; p=0.08) values were all higher in the pSS patients, but the differences were not statistically significant The results of the speckle tracking analysis were significantly different between the two groups, with global longitudinal strain deformation in the apical 4-chamber view (Long. ε 4c) being significantly lower in the pSS patients than in controls (Long ε 4c %:  median 15.28, IQR 12.3-16.2 vs 19.8, IQR 19.3-20.40; p<0.0001). 

Conclusion LV myocardial longitudinal ε measured by means of speckle tracking echocardiography  was impaired in our pSS patients in the absence of any clinical evidence of CV disease and when traditional echocardiographic evaluations were still negative, thus suggesting a myocardial alteration. However, further studies are required to define more precise methods of assessing CV disease in patients with pSS.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impaired-speckle-tracking-as-a-marker-of-subclinical-left-ventricular-dysfunction-in-patients-affected-by-primary-sjogrens-syndrome/