Meune Christophe, Allanore Yannick, Devaux Jean-Yves, Dessault Odile, Duboc Denis, Weber Simon, Kahan André
Department of Cardiology, Cochin Hospital, APHP, Paris V University, Paris, France.
J Rheumatol. 2004 Oct;31(10):1941-5.
To assess right ventricular (RV) function in patients with early systemic sclerosis (SSc) and the acute effects of calcium channel blockers on RV ejection fraction (RVEF).
Forty-two consecutive patients with SSc with less than 5 years' disease duration and normal pulmonary arterial pressure (35 women, 7 men; mean age 54.3 +/- 9.7 years; 16 with diffuse and 26 with limited cutaneous forms, systolic pulmonary arterial pressure 30.3 +/- 5.4 mmHg) were prospectively evaluated. All underwent pulmonary function testing, echocardiography, and radionuclide ventriculography at rest and 2 hours after receiving 40 mg oral nicardipine, and were compared at baseline with 20 gender and age matched controls.
None of the patients with SSc had clinical evidence of heart failure. At baseline, SSc patients had significantly lower LVEF (68.5% +/- 7.9 vs 72.4% +/- 5.0, p = 0.049) and RVEF (36.5% +/- 7.0 vs 45.8% +/- 5.7, p < 0.0001). Sixteen patients had reduced RVEF (< 35%), 3 had reduced LVEF (< 55%), and 10 had reduced peak filling rate (PFR). RVEF correlated to both LVEF and PFR (r = 0.64, p < 0.0001, and r = 0.36, p = 0.0037, respectively), whereas no correlation was found with pulmonary function impairment or pulmonary arterial pressure. Nicardipine resulted in a significant increase in RVEF (from 36.5% +/- 7.0 to 42.3% +/- 8.4, p < 0.001) whereas afterload indicated by mean arterial pressure did not differ significantly.
Reduced RVEF appears to be a common feature in early SSc; it may be due to intrinsic myocardial involvement and is acutely improved by nicardipine.
评估早期系统性硬化症（SSc）患者的右心室（RV）功能以及钙通道阻滞剂对右心室射血分数（RVEF）的急性影响。
前瞻性评估了42例连续的病程小于5年且肺动脉压正常的SSc患者（35例女性，7例男性；平均年龄54.3±9.7岁；16例弥漫性皮肤型，26例局限性皮肤型，收缩期肺动脉压30.3±5.4 mmHg）。所有患者均接受了肺功能测试、超声心动图检查以及静息状态下和口服40 mg尼卡地平2小时后的放射性核素心室造影，并在基线时与20例年龄和性别匹配的对照组进行比较。
SSc患者均无心力衰竭的临床证据。基线时，SSc患者的左心室射血分数（LVEF）显著降低（68.5%±7.9对72.4%±5.0，p = 0.049），右心室射血分数（RVEF）也显著降低（36.5%±7.0对45.8%±5.7，p < 0.0001）。16例患者的RVEF降低（< 35%），3例患者的LVEF降低（< 55%），10例患者的峰值充盈率（PFR）降低。RVEF与LVEF和PFR均相关（r分别为0.64，p < 0.0001和r为0.36，p = 0.0037），而与肺功能损害或肺动脉压无相关性。尼卡地平使RVEF显著增加（从36.5%±7.0增加至42.3%±8.4，p < 0.001），而平均动脉压所表示的后负荷无显著差异。
RVEF降低似乎是早期SSc的一个常见特征；它可能是由于心肌本身受累所致，并且尼卡地平可使其急性改善。
