The effect of cold stress on right ventricular function in patients with systemic sclerosis

Objective: Pulmonary hypertension and right heart failure are poor prognostic factors in systemic sclerosis (SSc). The effect of cold stress on pulmonary vasospasm was evaluated in some trials but the results were conflicting. The aim of our study was to determine the effect of cold stress on right ventricular (RV) function. Materials and Methods: Twenty-four patients with SSc and 24 age and sex-matched healthy controls were enrolled in the study. Transthoracic echocardiography (TIE) was performed to all patients at rest and after peripheral cold exposure. Baseline and after cold stress test TIE results were compared between the groups. Results: Cold exposure induced changes in particularly right venticular function. Pulmonary acceleration time was significantly shortened in the SSc group (118.8 +/- 11.7ms vs 111.3 +/- 13.7ms, P<0.001). Tricuspid annular plane systolic excurison and RV fractional area change were also decreased after cold exposure in the SSc group. (23.3 +/- 1.6mm vs 21.9 +/- 1.9 mm, P<0.001; 46.3 +/- 5.8 vs 44.4 +/- 5.8,P= 0.007, consecutively). Left ventricular (LV) function did not change after cold stress (LV myocardial performance index (0.42 +/- 0.04 vs 0.42 +/- 0.05), P=0.748). Conclusion: Peripheral cold exposure caused a reduction in right ventricular function indicating pulmonary Raynaud's phenomenon as a possible contributing factor.