Tissue Doppler imaging in systemic sclerosis: A 3-year longitudinal study

Objectives: To investigate by standard echocardiography and pulsed-tissue Doppler imaging (TDI) the course of systemic sclerosis (SSc) heart disease and its correlation with epidemiological, clinical, and serological features of the disease and drug treatment. Methods: A total of 74 consecutive patients (69 females, between the ages of 19 and 71 years, and disease duration 1-43 years) and 71 controls underwent cardiac assessment at baseline and at 3-year follow-up. Results: At baseline, compared to controls, patients showed post-Bonferroni correction, impaired left (LV) and right ventricular (RV) diastolic function (E-m/A(m) 0.85 +/- 0.4 vs 1.5 +/- 0.7, p = 0.0003; E-t/A(t) 0.9 +/- 0.3 vs 1.3 +/- 0.4, p = 0.0003), subtle LV and RV systolic dysfunction (S-m 13.7 +/- 2.7 vs 15.4 +/- 3.2 cm/s, p = 0.031; S-t < 11.5 cm/s in 16/74 patients vs 0 controls, p = 0.0031), and higher pulmonary artery systolic pressure (sPAP) (26.1 +/- 6.0 vs 24.1 +/- 5.1, p = 0.040). At 3-year follow-up, SSc patients showed a further deterioration of biventricular diastolic and systolic function and a further sPAP increase. At multiple regression analysis of baseline data, E-m/A(m) < 1 was detected in 55/74 patients vs 25/71 controls (p < 0.0001) and was associated with age (p = 0.030); E-t/A(t) < 1 was detected in 16/74 patients vs 7/71 controls (p < 0.0001), was associated with NYHA class >= II (p = 0.033), late capillaroscopic pattern (p = 0.029), and a baseline cardiac Medsger severity score >= 1 (p = 0.029). TDI evidence of new abnormalities in RV and/or LV diastolic function was associated with a baseline cardiac Medsger severity score >= 1 (p = 0.01). Neither diastolic or systolic abnormalities nor sPAP changes correlated with treatment. Conclusions: Our study confirms that SSc patients exhibit biventricular systolic and diastolic dysfunction and increased sPAP and reveals further deterioration at 3-year follow-up. (C) 2014 Published by Elsevier Inc.