A right ventricular diastolic impairment is common in systemic sclerosis and is associated with other target-organ damage

作者：Meune Christophe^*; Khanna Dinesh; Aboulhosn Jamil; Avouac Jerome^*; Kahan Andre; Furst Daniel E; Allanore Yannick

来源：Seminars in Arthritis and Rheumatism, 2016, 45(4): 439-445.

DOI：10.1016/j.semarthrit.2015.07.002

• Systemic sclerosis
• Cardiovascular
• Echocardiography
• Myocardial involvement
• Diastolic dysfunction
• Right ventricle

Objective: Heart involvement in systemic sclerosis (SSc) is a strong prognostic factor. Our aim was to examine left ventricle (LV) and right ventricle (RV) involvement.
Methods: We examined LV and RV, systolic and diastolic functions, using echocardiography and Tissue Doppler echocardiography (TDE) indexes, in a cohort of 212 consecutive SSc patients seen during a 9-month period at 2 institutions (Paris, France and Los Angeles, USA). They were compared to 50 healthy controls.
Results: When compared to controls, SSc patients had consistently impaired RV indices that include reduced RV contractility (p < 0.001), larger right atrial area (p = 0.027) and overall RV diastolic dys25% of SSc patients versus 0% of controls; p < 0.001). Patients also exhibited alterations in LV contractility and diastolic p < 0.001 each). In multivariate analysis, RV contractility as expressed by the TDE S-T parameter was associated with TDE LV contractility S-M (p = 0.030), DLCO. (p = 0.013) whereas RV diastolic impairment was associated with systolic pulmonary artery pressure (p = 0.015). A subgroup of 27 patients had proven pulmonary arterial hypertension (PAH); comparison between SSc-PAH versus SSc free of PAH patients revealed reduced LV diastolic transmitral E/A ratio, p = 0.045 and E-A < 10 cm/s, p = 0.029), reduced overall RV contractility (21.5% versus 4.5%; p = 0.03) and reduced RV diastolic transtricuspid E/A ratio; p = 0.014 and 68% versus 29% with impaired function; p = 0.001).
Conclusions: Our data show that RV is commonly affected in SSc with predominant impaired diastolic function. Several factors, including primary heart, lung vascular disease and pulmonary hypertension, contribute to such impairment.

• 出版日期2016-2