Department of Cardiology, Medipol University Hospital, Istanbul, Turkey.
Department of Cardiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
Lung. 2018 Apr;196(2):173-178. doi: 10.1007/s00408-018-0098-6. Epub 2018 Feb 14.
Systemic sclerosis (SSc) is a chronic, inflammatory, and autoimmune connective tissue disease that is associated with vascular lesions, and fibrosis of the skin and visceral organs. Cardiac complications may occur as a secondary effect of SSc as a result of pulmonary arterial hypertension and interstitial lung disease. The objective of this study was to assess whether the pulmonary pulse transit time (pPTT) could serve as a diagnostic marker for pulmonary arterial alterations in patients with SSc, prior to development of pulmonary hypertension.
Twenty-five SSc patients as a study group and 25 age- and sex-matched healthy volunteers for the control group were recruited to the study. Right ventricle function parameters, such as tricuspid annular plane systolic excursion (TAPSE), estimated pulmonary artery systolic pressure (ePASP), right ventricular dimensions, right ventricle fractional area changes, and myocardial perfusion index (MPI) were measured and calculated. Pulmonary pulse transit time was defined as the time interval between the R-wave peak in the ECG and the corresponding peak late systolic pulmonary vein flow velocity.
Right ventricle myocardial performance index (RVMPI) and eSPAP were significantly higher in the SSc group than the controls (p = 0.032, p = 0.012, respectively). Pulmonary pulse transit time and TAPSE was shorter in the patients with SSc (p = 0.006, p = 0.015, respectively). In correlation analysis, pPTT was inversely correlated with RVMPI (r = - 0.435, p = 0.003), eSPAP (r = - 0.434, p = 0.003), and disease duration (r = - 0.595, p = 0.003). Conversely, it positively correlated with TAPSE (r = 0.345, p = 0.022).
pPTT was found to be shorter in SSc patients. pPTT might serve as a surrogate marker of pulmonary hemodynamics in patients with SSc, even prior to the development of pulmonary hypertension.
系统性硬化症（SSc）是一种慢性炎症性自身免疫性结缔组织疾病，与血管病变以及皮肤和内脏器官纤维化有关。心脏并发症可能是 SSc 的继发效应，由肺动脉高压和间质性肺病引起。本研究的目的是评估肺动脉脉搏传递时间（pPTT）是否可作为 SSc 患者肺动脉改变的诊断标志物，在肺动脉高压发生之前。
将 25 名 SSc 患者作为研究组和 25 名年龄和性别匹配的健康志愿者作为对照组纳入研究。测量和计算右心室功能参数，如三尖瓣环平面收缩期位移（TAPSE）、估计肺动脉收缩压（ePASP）、右心室大小、右心室分数面积变化和心肌灌注指数（MPI）。肺动脉脉搏传递时间定义为心电图 R 波峰值与相应肺动脉收缩期血流速度峰值之间的时间间隔。
SSc 组的右心室心肌性能指数（RVMPI）和 eSPAP 明显高于对照组（p=0.032，p=0.012）。SSc 患者的肺动脉脉搏传递时间和 TAPSE 更短（p=0.006，p=0.015）。在相关分析中，pPTT 与 RVMPI（r=-0.435，p=0.003）、eSPAP（r=-0.434，p=0.003）和疾病持续时间（r=-0.595，p=0.003）呈负相关。相反，它与 TAPSE 呈正相关（r=0.345，p=0.022）。
SSc 患者的 pPTT 更短。pPTT 可能是 SSc 患者肺动脉血流动力学的替代标志物，甚至在肺动脉高压发生之前。
