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

Authors

1 Cardiovascular Research Center,Mashhad University of Medical Sciences,Mashhad, IR Iran

2 Mashhad University of Medical Sciences,Mashhad, IR Iran

3 Razavi Cancer Research Center, Razavi Hospital, Imam Reza International University, Mashhad, Iran

4 Rheumatic Disease Research Center,Mashhad University of Medical Sciences,Mashhad, IR Iran

5 Associate Professor of Cardiology, Razavi Hospital,Mashhad University of Medical Sciences,Mashhad, IR Iran

Abstract

Abstract Background: Pulmonary arterial hypertension (PAH) is a leading cause of death in systemic sclerosis (SSc) patients. Early detection of 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 beenmade to find a new possible nonin- vasive echocardiographic test for early diagnosis of systolic failure as a PAH complication. Methods: 30 patientswith at least a 2-year history of diffuse SSc confirmed by an expert rheumatologistwere enrolled in this study. All the patients underwent transthoracic echocardiography by an echocardiologist. Fractional area change (FAC) of the right ven- tricle (RV), tricuspid annular plane systolic excursion (TAPSE), RV lateralwall strain and strain rate (Base,Mid, Apex), RV-EDD and RV pressure 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 RV parameters. LVEF was found to be significantly higher in women whereas RV strain turned out to be higher inmen. Besides, there was 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 relationwas 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 bodymass index (BMI) and RV parameters (P > 0.05). Moreover, Apical RV strain and LVEF were found to be higher inmales and females respectively. Furthermore, a significant relationshipwas found between RV strain and age (P = 0.027). Finally, the results did not show any relationship between RV systolic and diastolic functions and gender. Conclusions: This paper states the likely advantages of strain and strain rate echocardiography in identifying patients withmore diffused and severe SSc and the need for further longitudinal studies based on thementionedmethod for early diagnosis ofmyocar- dial impairment.

Keywords

References

  1. 1.Fauci AS, Langford C. Harrison’s rheumatology. McGraw Hill Professional; 2010.

    1. Isselbacher KJ, Adams RD. Harison’s Principles of internal medicine. New York: Mc Graw-Hill Book Company; 2010.
    2. Braunwald E, Bonow RO. Braunwald’s heart disease. Elsevier Saunders; 2012.
    3. Denton CP, Cailes JB, Phillips GD, Wells AU, Black CM, Bois RM. Comparison of Doppler echocardiography and right heart catheterization to assess pulmonary hypertension in systemic sclerosis. Br J Rheumatol. 1997;36(2):239–43. [PubMed: 9133938].
    4. Vonk Noordegraaf A, Naeije R. Right ventricular function in scleroderma-related pulmonary hypertension. Rheumatology (Oxford). 2008;47 Suppl 5:v42–3. doi: 10.1093/rheumatology/ken284. [PubMed: 18784141].
    5. Schattke S, Knebel F, Grohmann A, Dreger H, Kmezik F, Riemekasten G, et al. Early right ventricular systolic dysfunction in patients with systemic sclerosis without pulmonary hypertension: a Doppler Tissue and Speckle Tracking echocardiography study. Cardiovasc Ultrasound. 2010;8:3. doi: 10.1186/1476-7120-8-3. [PubMed: 20096122].
    6. Codullo V, Caporali R, Cuomo G, Ghio S, D’Alto M, Fusetti C, et al. Stress Doppler echocardiography in systemic sclerosis: evidence for a role in the prediction of pulmonary hypertension. Arthritis Rheum. 2013;65(9):2403–11. doi: 10.1002/art.38043. [PubMed: 23754201]. 8. Ciurzynski M, Bienias P, Lichodziejewska B, Szewczyk A, GlinskaWielochowska M, Jankowski K, et al. Assessment of left and right ventricular diastolic function in patients with systemic sclerosis. Kardiol Pol. 2008;66(3):269–76. [PubMed: 18393114] discussion 277-8.
    7. Coghlan JG, Denton CP, Grunig E, Bonderman D, Distler O, Khanna D, et al. Evidence-based detection of pulmonary arterial hypertension in systemic sclerosis: the DETECT study. Ann Rheum Dis. 2014;73(7):1340– 9. doi: 10.1136/annrheumdis-2013-203301. [PubMed: 23687283].
    8. Vonk MC, Sander MH, van den Hoogen FH, van Riel PL, Verheugt FW, van Dijk AP. Right ventricle Tei-index: a tool to increase the accuracy of non-invasive detection of pulmonary arterial hypertension in connective tissue diseases. Eur J Echocardiogr. 2007;8(5):317–21. doi: 10.1016/j.euje.2006.06.002. [PubMed: 16846757].
    9. Acosta Colman MI, Avila Pedretti G, Acosta ME, Simeon Aznar CP, Fonollosa Pla V, Villardel Torres M. Can we predict the severity of pulmonary hypertension in patients with scleroderma?. Reumatol Clin. 2012;8(5):259–62. doi: 10.1016/j.reuma.2012.03.007. [PubMed: 22658662].
    10. D’Andrea A, Stisi S, Bellissimo S, Vigorito F, Scotto di Uccio F, Tozzi N, et al. Early impairment of myocardial function in systemic sclerosis: non-invasive assessment by Doppler myocardial and strain rate imaging. Eur J Echocardiogr. 2005;6(6):407–18. doi: 10.1016/j.euje.2005.01.002. [PubMed: 16293527].
    11. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification. Eur J Echocardiogr. 2006;7(2):79–108. doi: 10.1016/j.euje.2005.12.014. [PubMed: 16458610].
    12. Weyman AE. Principles and practice of echocardiography. USA: Lea and Febiger; 1994.
    13. Kanski M, Arheden H, Wuttge DM, Bozovic G, Hesselstrand R, Ugander M. Pulmonary blood volume indexed to lung volume is reduced in newly diagnosed systemic sclerosis compared to normals–a prospective clinical cardiovascular magnetic resonance study addressing pulmonary vascular changes. J Cardiovasc Magn Reson. 2013;15:86. doi: 10.1186/1532-429X-15-86. [PubMed: 24066703].
    14. Jansa P, Becvar R, Ambroz D, Palecek T, Tomcik M, Skacelova S, et al. Pulmonary arterial hypertension associated with systemic sclerosis in the Czech Republic. Clin Rheumatol. 2012;31(3):557–61. doi: 10.1007/s10067-011-1896-x. [PubMed: 22105781].
    15. Vitarelli A, Mangieri E, Terzano C, Gaudio C, Salsano F, Rosato E, et al. Three-dimensional echocardiography and 2D-3D speckle-tracking imaging in chronic pulmonary hypertension: diagnostic accuracy in detecting hemodynamic signs of right ventricular (RV) failure. J Am Heart Assoc. 2015;4(3):e001584. doi: 10.1161/JAHA.114.001584. [PubMed: 25792128].
    16. Stergiopoulos K, Bahrainy S, Strachan P, Kort S. Right ventricular strain rate predicts clinical outcomes in patients with acute pulmonary embolism. Acute Card Care. 2011;13(3):181–8. doi: 10.3109/17482941.2011.606468. [PubMed: 21877878].
    17. Chow PC, Liang XC, Cheung EW, Lam WW, Cheung YF. New twodimensional global longitudinal strain and strain rate imaging for assessment of systemic right ventricular function. Heart. 2008;94(7):855–9. doi: 10.1136/hrt.2007.131862. [PubMed: 18230639].
    18. Utsunomiya H, Nakatani S, Okada T, Kanzaki H, Kyotani S, Nakanishi N, et al. A simple method to predict impaired right ventricular performance and disease severity in chronic pulmonary hypertension using strain rate imaging. Int J Cardiol. 2011;147(1):88–94. doi: 10.1016/j.ijcard.2009.08.009. [PubMed: 19747741].
    19. Filusch A, Mereles D, Gruenig E, Buss S, Katus HA, Meyer FJ. Strain and strain rate echocardiography for evaluation of right ventricular dysfunction in patients with idiopathic pulmonary arterial hypertension. Clin Res Cardiol. 2010;99(8):491–8. doi: 10.1007/s00392-010-0147- 5. [PubMed: 20352437]. 6 Razavi Int J Med. 2016; 4(3):e37144. Rezai Yazdi Z et al.
    20. Iudici M, Codullo V, Giuggioli D, Riccieri V, Cuomo G, Breda S, et al. Pulmonary hypertension in systemic sclerosis: prevalence, incidence and predictive factors in a large multicentric Italian cohort.
Razavi International Journal of Medicine
Volume 4, Issue 3
September 2016

Files

Share

How to cite

Statistics