Durmus E, Sunbul M, Tigen K, Kivrak T, Ozen G, Sari I, Direskeneli H, Basaran Y
Faculty of Medicine, Department of Cardiology, Marmara University, Fevzi Cakmak Mahallesi, Mimar Sinan Caddesi, No: 41 Ustkaynarca, Pendik, Istanbul, Turkey.
Herz. 2015 Jun;40(4):709-15. doi: 10.1007/s00059-014-4113-2. Epub 2014 Jun 19.
Systemic sclerosis (SSc) is a systemic connective tissue disease and cardiac involvement is one of the most important causes of death. Right ventricular (RV) systolic dysfunction is a poor prognostic finding in SSc patients. Assessment of RV function has some difficulties because of its crescent shape and extensive trabeculations. Two-dimensional (2D) speckle-tracking echocardiography (STE) is an angle-independent quantitative technique to evaluate myocardial function. The aim of this study was to assess the RV and right atrial (RA) functions of SSc patients without pulmonary hypertension by using 2D STE.
A total of 40 patients with SSc (mean age 48.5 ± 11.4 years, 28 female) and 40 healthy volunteers (mean age 45.9 ± 7.6 years, 21 female) were included in the study. All subjects underwent transthoracic echocardiography for evaluation of RV and RA functions with 2D STE.
Although left ventricular systolic and diastolic functions, systolic pulmonary artery pressure (PAP), and RA measurements were similar in both groups, tricuspid annular plane systolic excursion (TAPSE) and maximum systolic myocardial velocity (S') were decreased in SSc patients. The RV free wall global longitudinal strain (GLS) of SSc patients was lower than the controls (- 18.5 ± 4.9 % vs. - 21.8 ± 2.4 %, p < 0.001) and the RA reservoir and conduit functions were also decreased in SSc patients compared with controls (34.4 ± 9.9 % vs. 39.7 ± 11.2 %, p = 0.027 and 15.0 ± 5.7 % vs. 18.7 ± 6.4 %, p = 0.009, respectively). Disease duration was inversely correlated with RVGLS and TAPSE (r: - 0.416, p = 0.018 and r: - 0.383, p = 0.031, respectively).
The use of 2D STE can be helpful in the detection of impairment in RV and RA functions in SSc patients with normal PAP.
系统性硬化症（SSc）是一种全身性结缔组织疾病，心脏受累是最重要的死亡原因之一。右心室（RV）收缩功能障碍在SSc患者中是预后不良的表现。由于右心室呈新月形且有广泛的小梁结构，评估其功能存在一定困难。二维（2D）斑点追踪超声心动图（STE）是一种不依赖角度的评估心肌功能的定量技术。本研究的目的是使用2D STE评估无肺动脉高压的SSc患者的右心室和右心房（RA）功能。
本研究共纳入40例SSc患者（平均年龄48.5±11.4岁，女性28例）和40名健康志愿者（平均年龄45.9±7.6岁，女性21例）。所有受试者均接受经胸超声心动图检查，采用2D STE评估右心室和右心房功能。
尽管两组的左心室收缩和舒张功能、收缩期肺动脉压（PAP）及右心房测量值相似，但SSc患者的三尖瓣环平面收缩期位移（TAPSE）和最大收缩期心肌速度（S'）降低。SSc患者右心室游离壁整体纵向应变（GLS）低于对照组（-18.5±4.9%对-21.8±2.4%，p<0.001），与对照组相比，SSc患者右心房的储器和管道功能也降低（分别为34.4±9.9%对39.7±11.2%，p=0.027；15.0±5.7%对18.7±6.4%，p=0.009）。疾病持续时间与右心室GLS和TAPSE呈负相关（r分别为-0.416，p=0.018；r为-0.383，p=0.031）。
使用2D STE有助于检测PAP正常的SSc患者右心室和右心房功能的损害。
