Echocardiographic Test and the Early Detection of Systolic Failure in Systemic Sclerosis Patients: Strain and Strain Rate Echocardiography

Background: Pulmonary arterial hypertension (PAH) is a leading cause of death in systemic sclerosis (SSc) patients. Early detectionof systolic failure in SSc patients will facilitate early treatment and improve the survival rate of these patients.Objectives: In this study, besides studying the RV function in SSC patients, attempts have been made to find a new possible noninvasiveechocardiographic test for early diagnosis of systolic failure as a PAH complication.Methods: 30 patients with at least a 2-year history of diffuse SSc confirmed by an expert rheumatologist were enrolled in this study.All the patients underwent transthoracic echocardiography by an echocardiologist. Fractional area change (FAC) of the right ventricle(RV), tricuspid annular plane systolic excursion (TAPSE), RV lateral wall strain and strain rate (Base, Mid, Apex), RV-EDD and RVpressure with respect to inferior vena cava (IVC) diameter as well as Left Ventricle’s Ejection Fraction (LVEF) were evaluated.Results: The prevalence rate of PAH was reported 36.6% in this study. There was no significant relationship between LVEF and RVparameters. LVEF was found to be significantly higher in women whereas RV strain turned out to be higher in men. Besides, therewas a significant relation between pulmonary arterial pressure (PAP) and Basal (P = 0.03), mid RV strain (P = 0.002), RV strain rate (P= 0.001) and RV diameter (P = 0.02). Also, an inverse relation was observed between RV systolic (P = 0.01) and diastolic functions (P =0.007) with PAP. In addition, no significant relationship was found between LVEF and body mass index (BMI) and RV parameters (P> 0.05). Moreover, Apical RV strain and LVEF were found to be higher in males and females respectively. Furthermore, a significantrelationship was found between RV strain and age (P = 0.027). Finally, the results did not show any relationship between RV systolicand diastolic functions and gender.Conclusions: This paper states the likely advantages of strain and strain rate echocardiography in identifying patients with morediffused and severe SSc and the need for further longitudinal studies based on the mentioned method for early diagnosis of myocardialimpairment.

Keywords:

Scleroderma , Systemic Sclerosis (SSc) , Pulmonary Arterial Hypertension (PAH) , Right Ventricle (RV ) function , SystolicFailure , Tissue Doppler Imaging (TDI) , Strain and Strain Rate Echocardiography