Unique Abnormalities in Right Ventricular Longitudinal Strain in Systemic Sclerosis Patients

作者：Mukherjee Monica; Chung Shang En; Ton Von Khue; Tedford Ryan J; Hummers Laura K; Wigley Fredrick M; Abraham Theodore P; Shah Ami A

来源：Circulation-Cardiovascular Imaging, 2016, 9(6): e003792.

DOI：10.1161/CIRCIMAGING.115.003792

• cardiomyopathies
• heart ventricles
• hypertension, pulmonary
• scleroderma, systemic
• ventricular function, right

Background-Cardiac involvement in systemic sclerosis (scleroderma [SSc]) adversely affects long-term prognosis, often remaining undetectable despite close clinical examination and 2-dimensional echocardiographic monitoring. Speckle-derived strain of the right ventricle (RV) was utilized to detect occult abnormalities in regional and global contractility in SSc patients.
Methods and Results-A total of 138 SSc patients with technically adequate echocardiograms was studied and compared with 40 age-and sex-matched healthy non-SSc controls. Standard assessment of RV chamber function included tricuspid annular plane systolic excursion and fractional area change. RV longitudinal systolic speckle-derived strain was assessed in the basal, mid, and apical free wall. Tricuspid annular plane systolic excursion was not different between groups (P = 0.307). Although fractional area change was lower in SSc patients than in controls (mean, 48.9 versus 55; P = 0.002), the mean fractional area change was still within the normal range (>35). In contrast, RV longitudinal systolic specklederived strain measures were significantly different between groups, both globally (-20.4% versus -17.7%; P = 0.005) and regionally: they were decreased in the apex (-8.5% versus -17.1%; P < 0.0001) and mid segments (-12.4% versus -20.9%; P < 0.0001), and increased in the base (-32.2% versus -23.3%; P = 0.0001) for the SSc group. The regional difference in the base compared with the apex was significantly greater for SSc than for controls (P < 0.0001 for interaction). The differences observed in regional strain between SSc and control were unchanged after adjusting for RV systolic pressure.
Conclusions-Speckle-derived strain reveals a heterogenous pattern of regional heart strain in SSc that is not detected by conventional measures of function, suggestive of occult RV myocardial disease.

• 出版日期2016-6