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Abstract Number: 740

Right Ventricular Diastolic Impairment Is Common in Systemic Sclerosis and Is a Marker of Several Organ-Target Damage of the Disease

Christophe Meune1, Dinesh Khanna2, Jamil Aboulhosn3, Jerome Avouac4, Andre Kahan5, Daniel E. Furst6 and Yannick Allanore4, 1Paris 13 University, University Hospital of Paris-Seine-Saint-Denis, Cardiology Department, Bobigny, France, 2University of Michigan Health System, Ann Arbor, MI, 3Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 4Paris Descartes University, Rheumatology A Department and INSERM U1016, Cochin Hospital, Paris, France, 5Paris Descartes University, Rheumatology A department, Cochin Hospital, Paris, France, 6University of California, Los Angeles, Department of Medicine, Los Angeles, CA

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Systemic sclerosis

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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

Heart failure and cardiac dysfunctions both of intrinsic or secondary origin and targeting LV (left ventricule) and/or RV (right ventricule) are critical complications promoting mortality in systemic sclerosis (SSc). While several studies reported possible right ventricule (RV) alterations in SSc patients having pulmonary hypertension, only few and small series investigated RV function in unselected SSc patients. Therefore, the aim of the present study is to investigate LV and RV systolic and diastolic function in a large SSc cohort of unselected patients compared to a control group using comprehensive echocardiographic parameters.

Methods

We examined LV and RV systolic and diastolic functions, using echocardiography and Tissue Doppler echocardiography (TDE) indexes, in a cohort of 212 consecutive SSc patients seen during a 9 month-period at two institutions (Paris, France and Los Angeles, USA) and 50 healthy controls.

Results

Patients’ characteristics from the two institutions were very similar allowing combined analyses. When compared to controls, SSc patients had consistently impaired RV indices that include reduced RV contractility (p<0.001), larger right atrial area (p=0.027) and overall RV diastolic dysfunction (p<0.001) (Table 1). Patients also exhibited alterations in LV contractility and diastolic function (p<0.001 each) (Table 1). Looking at associated parameters, in multivariate analysis, RV contractility as expressed by the TDE ST parameter was associated with TDE LV contractility SM (p=0.030), DLCO (p=0.013) whereas RV diastolic impairment was associated with systolic pulmonary artery pressure (p=0.015). In a subset of 27 patients with proven pre-capillary PAH, comparison between SSc-PAH versus SSc free of PAH patients, revealed reduced LV diastolic function (measured by transmitral E/A ratio (p=0.045) and EA <10cm/s (p=0.029)), reduced overall RV contractility (21.5 versus 4.5%; P=0.03) and reduced RV diastolic function (transtricuspid E/A ratio; p=0.014 and 68% versus 29% with impaired function; p=0.001).

Conclusion:

Whereas most previous studies focused on the LV, we report in the present controlled study that not only systolic but also diastolic RV dysfunction is common in SSc and that several cardiopulmonary factors seem to influence RV function in this multifaceted disease. Given that RV dysfunction and fibrosis are poor prognosticator, possibly associated with lethal ventricular arrhythmias, sudden death, exercise limitation, and impaired RV cardiac output, we assume that RV function should be closely investigated in SSc patients and that the impact on RV diastolic function of future therapies targeting PAH and/or primary myocardial involvement is to be assessed.

Table 1:

SSc patients

(n=212)

Controls

(n=50)

p

Age, years

55.3±13.2

53.1±11.0

0.201

Men/women

40/172

8/42

0.637

Heart rate, bpm

76±11

69±15

0.001

Blood pressure, mmHg

Systolic

Diastolic

122 ± 14

70 ± 9

123±14

69±9

0.536

0.490

LV indexes

Left ventricular end-diastolic diameter, mm

43±6

47±7

0.002

Interventricular septum thickness, mm

10±3

10±1

0.846

Left ventricular ejection fraction, %

61±7

67±3

<0.001

Left ventricular ejection fraction <55%, n (%)

8 (3.9)

0 (0.0)

0.361

Left atrial area, mm²

14±4

13±2

0.418

Mitral doppler E/A ratio

1.0±1.0

1.2±0.3

<0.001

SM, cm/s

9.8±2.2

11.9±2.7

<0.001

SM <7.5 cm/s, n

23 (10.8)

0 (0.0)

0.010

Ea <10 cm/s, n

76 (35.8)

6 (12.0)

<0.001

RV indexes

Tricuspid doppler E/A ratio

1.2±0.4

1.3±0.3

0.023

ST, cm/s

13.2±2.7

14.7±2.7

<0.001

ST <10 cm/s, n (%)

11 (5.2)

0 (0.0)

0.128

Tricuspid annular plane systolic excursion, mm

21.9±4.0

23.9±2.0

<0.001

Right atrial area, mm²

15±8

12±2

0.027

RV diastolic dysfunction, n (%)

53 (25.0)

0 (0.0)

<0.001

Pericardial and pulmonary artery measurements

Pericardial effusion, n (%)

27 (12.7)

4 (9.1)

0.618

Tricuspid regurgitation maximal velocity (m/s)

2.5±0.4

2.4±0.2

0.491

Pulmonary arterial pressure, mmHg

33±10

31±5

0.496

Pulmonary arterial pressure >40 mmHg, n (%)

29 (13.7)

0 (0.0)

0.002



Disclosure:

C. Meune,
None;

D. Khanna,
None;

J. Aboulhosn,
None;

J. Avouac,
None;

A. Kahan,
None;

D. E. Furst,
None;

Y. Allanore,
None.

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