Karaahmet Tansu, Tigen Kursat, Gurel Emre, Takir Mumtaz, Avci Anil, Cevik Cihan, Pala Selcuk, Dundar Cihan, Basaran Yelda
Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
Heart Vessels. 2010 May;25(3):223-8. doi: 10.1007/s00380-009-1197-3. Epub 2010 May 29.
Primary myocardial involvement is common in systemic sclerosis (SSc). We evaluated the atrial and ventricular electromechanical characteristics by using tissue Doppler echocardiography in SSc patients with subclinical cardiac involvement. Twenty-seven consecutive patients (24 women; mean age +/- SD 49.9 +/- 11.3 years) presenting with SSc without pulmonary arterial hypertension or symptomatic heart failure were prospectively studied. Electrocardiographic P-wave dispersion (Pd), corrected QT dispersion (QTcd), interatrial, intra-atrial, interventricular, and intraventricular electromechanical delays were analyzed by tissue Doppler echocardiography, and brain natriuretic peptide levels were measured. Results were compared with 17 healthy controls. There was no difference in conventional and tissue Doppler parameters between the two groups. However, patients with SSc had higher mean Pd (mean [+/-SD] 46.8 +/- 15 and 36 +/- 8 ms, respectively, P = 0.004) and mean interatrial electromechanical delay time (DT) (mean [+/-SD] 32.2 +/- 9.2 and 24.7 +/- 9.7 ms, respectively, P = 0.01), mean electromechanical delay time for all segments (Mean Ts) (mean [+/-SD] 148.8 +/- 18.8 and 129.3 +/- 13.4 ms, respectively, P < 0.001), and intraventricular DT (mean [+/-SD] 27.6 +/- 12.5 and 16.2 +/- 7.2 ms, respectively, P < 0.001). Intraventricular DT was the only parameter that correlated significantly with the Mean Ts. Brain natriuretic peptide levels were within normal limits in both groups; however, they were higher in patients with SSc than in controls (mean [+/-SD] 37.5 +/- 28.5 and 23.1 +/- 16.0 pg/ml, respectively, P = 0.03). The evaluation of atrial and ventricular electromechanical parameters by using tissue Doppler echocardiography seems to be useful for detection of subclinical cardiac involvement in SSc patients with normal conventional echocardiographic findings.
原发性心肌受累在系统性硬化症（SSc）中很常见。我们使用组织多普勒超声心动图评估了亚临床心脏受累的SSc患者的心房和心室机电特征。前瞻性研究了27例连续出现的无肺动脉高压或症状性心力衰竭的SSc患者（24名女性；平均年龄±标准差49.9±11.3岁）。通过组织多普勒超声心动图分析心电图P波离散度（Pd）、校正QT离散度（QTcd）、心房内、心室内、心室间和心室内机电延迟，并测量脑钠肽水平。将结果与17名健康对照者进行比较。两组之间的传统和组织多普勒参数没有差异。然而，SSc患者的平均Pd（分别为平均[±标准差]46.8±15和36±8毫秒，P = 0.004）、平均心房机电延迟时间（DT）（分别为平均[±标准差]32.2±9.2和24.7±9.7毫秒，P = 0.01）、所有节段的平均机电延迟时间（平均Ts）（分别为平均[±标准差]148.8±18.8和129.3±13.4毫秒，P < 0.001）和心室内DT（分别为平均[±标准差]27.6±12.5和16.2±7.2毫秒，P < 0.001）更高。心室内DT是唯一与平均Ts显著相关的参数。两组的脑钠肽水平均在正常范围内；然而，SSc患者的脑钠肽水平高于对照组（分别为平均[±标准差]37.5±28.5和23.1±16.0皮克/毫升，P = 0.03）。对于传统超声心动图检查结果正常的SSc患者，使用组织多普勒超声心动图评估心房和心室机电参数似乎有助于检测亚临床心脏受累。
