Department of Rheumatology and Immunology.
Department of Cardiology, People's Hospital, Peking University.
Rheumatology (Oxford). 2022 May 30;61(6):2432-2440. doi: 10.1093/rheumatology/keab724.
Cardiac involvement is a major cause of death in SSc, while early detection remains a challenge.
The purpose of this study was to investigate the prevalence and clinical implications of cardiac impairment in SSc.
Ninety-five consecutive SSc patients [55.6 (13.8) years old, 5.3 (8.1) years from diagnosis] were included in the study. Patients with heart diseases onset prior to SSc were excluded. All patients underwent two-dimensional speckle-tracking echocardiology (2D-STE) with measuring left and right ventricular global longitudinal strain (GLS/RGLS). Clinical manifestation, laboratory evaluation (CRP, cTnI, antibodies, etc.) and ECG were collected at the same time. Comparisons between the SSc subgroups (lcSSc and dcSSc) were performed using Student's t-test, Mann-Whitney U or Fisher's exact test. Binary logistic regression was applied to determine the independent effects of variables in cardiac impairment.
Early left and right ventricular impairment measured by GLS and RGLS were detected in 22.1% and 24.2% of the SSc patients, respectively. In comparison, only 2.1% showed reduced left ventricular ejection fraction (LVEF). Impaired GLS was mainly observed in the basal and medial segments of anterior, lateral and posterior left ventricle walls, and more profound in dcSSc. Elevated CRP (OR 3.561 95% CI: 1.071, 11.839, P <0.05) was associated with reduced GLS/RGLS. The adoption of GLS/RGLS enhanced the efficacy of routine screening for cardiac impairment that 52.6% of patients showed potential cardiac impairment.
Cardiac impairment is a common manifestation in SSc. Increasing awareness of early cardiac impairment is warranted with elevated CRP and dcSSc.
心脏受累是系统性硬化症（SSc）患者死亡的主要原因，而早期检测仍然是一个挑战。
本研究旨在探讨 SSc 患者心脏损害的发生率及其临床意义。
共纳入 95 例连续的 SSc 患者[55.6±13.8 岁，诊断后 5.3±8.1 年]，排除了先于 SSc 发生的心脏病患者。所有患者均接受二维斑点追踪超声心动图（2D-STE）检查，测量左、右心室整体纵向应变（GLS/RGLS）。同时采集患者的临床表现、实验室评估（CRP、cTnI、抗体等）和心电图。使用 Student's t 检验、Mann-Whitney U 检验或 Fisher 确切概率法比较 SSc 亚组（lcSSc 和 dcSSc）之间的差异。采用二元逻辑回归分析确定心脏损害相关变量的独立影响。
22.1%和 24.2%的 SSc 患者分别存在早期左、右心室功能障碍，表现为 GLS 和 RGLS 降低。相比之下，只有 2.1%的患者出现左心室射血分数（LVEF）降低。GLS 降低主要见于左心室前壁、侧壁和后壁的基底段和中段，dcSSc 患者更为明显。CRP 升高（OR 3.561，95%CI：1.071，11.839，P<0.05）与 GLS/RGLS 降低相关。与常规筛查相比，采用 GLS/RGLS 可提高 52.6%潜在心脏损害患者的心脏损害检出率。
心脏损害在 SSc 中较为常见。CRP 升高和 dcSSc 患者应提高对早期心脏损害的认识。
