V. Mercurio, MD, PhD, Assistant Professor of Medicine, University of Naples Federico II, Department of Translational Medical Sciences, and Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine.
A.M. Hinze, MD, Assistant Professor of Medicine, Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
J Rheumatol. 2021 Aug;48(8):1299-1306. doi: 10.3899/jrheum.200873. Epub 2021 Jan 15.
Primary cardiac involvement in systemic sclerosis (SSc) is prevalent and morbid; however, the influence of traditional cardiovascular (CV) risk factors, such as essential hypertension (HTN), are unclear. In the present study, we sought to understand the effects of HTN on left ventricular (LV) contractility in patients with SSc using echocardiographic speckle-derived global longitudinal strain (GLS).
Fifty-six SSc patients with HTN (SSc+HTN+) and 82 SSc patients without HTN (SSc+ HTN-) were compared with 40 non-SSc controls with HTN (SSc-HTN+) and 40 non-SSc controls without HTN (SSc-HTN-), matched by age and sex. All HTN patients were on stable antihypertensive therapies. Echocardiographic measures included LV (LV) ejection fraction (LVEF), left atrial volume index (LAVI), and LV diastolic function. LV contractility was assessed by GLS, averaged across the 18 LV segments.
Patients with SSc had diminished GLS regardless of HTN status when compared to both control groups, despite normal LVEF ( 0.001). SSc+HTN+ had the highest prevalence of diastolic dysfunction, with significantly higher septal E/e´, a marker of LV filling pressures ( 0.05), as well as the largest reduction in GLS compared to SSc+HTN- and both control groups.
Speckle-derived strain revealed diminished LV contractility in patients with SSc, despite normal LVEF. SSc+HTN+ had more prominent reductions in GLS associated with evidence of LV remodeling and worsened diastolic function. Our findings demonstrate the presence of subclinical LV contractile dysfunction in SSc that is further exacerbated by concomitant HTN, thereby identifying HTN as an important modifiable CV risk factor that should be managed aggressively in this at-risk population.
系统性硬化症（SSc）的心脏原发性受累较为常见且病情严重；然而，传统心血管（CV）危险因素（如原发性高血压（HTN））的影响尚不清楚。在本研究中，我们试图通过超声心动图斑点追踪衍生的整体纵向应变（GLS）来了解 HTN 对 SSc 患者左心室（LV）收缩功能的影响。
将 56 例 SSc 合并 HTN（SSc+HTN+）患者和 82 例 SSc 无 HTN 患者（SSc+HTN-）与 40 例非 SSc 合并 HTN 患者（SSc-HTN+）和 40 例非 SSc 无 HTN 患者（SSc-HTN-）进行比较，两组均按年龄和性别匹配。所有 HTN 患者均接受稳定的降压治疗。超声心动图指标包括左心室（LV）射血分数（LVEF）、左心房容积指数（LAVI）和 LV 舒张功能。通过 GLS 评估 LV 收缩功能，取 18 个 LV 节段的平均值。
与两组对照相比，无论 HTN 状态如何，SSc 患者的 GLS 均降低，尽管 LVEF 正常（ 0.001）。SSc+HTN+患者舒张功能障碍的发生率最高，其室间隔 E/e'显著升高，这是 LV 充盈压的标志物（ 0.05），与 SSc+HTN-和两组对照相比，GLS 降低最明显。
斑点追踪应变显示，尽管 LVEF 正常，SSc 患者的 LV 收缩功能仍降低。SSc+HTN+患者的 GLS 降低更明显，伴有 LV 重构和舒张功能恶化的证据。我们的研究结果表明，SSc 存在亚临床 LV 收缩功能障碍，合并 HTN 时进一步加重，这表明 HTN 是这一高危人群中一种重要的可改变的 CV 危险因素，应积极加以控制。
