Abstract 19659: Early Detection of Right Ventricular Dysfunction Using Speckle-Tracking Echocardiography in Systemic Sclerosis Patients
Background: Cardiac involvement in systemic sclerosis (SSc) adversely affects long-term prognosis, remaining undetectable despite frequent echocardiographic monitoring. Speckle tracking derived strain of the RV free wall was utilized to detect early changes in regional and global contractility in SSc patients.
Methods: 138 SSc patients who had technically adequate, clinically indicated 2D echocardiograms were studied, and compared with a cohort of 40 age-matched non-scleroderma controls (C). Conventional 2D and off-line strain analysis were performed using commercially available software. RV longitudinal systolic strain (RVLSS) was assessed in the basal, mid and apical free wall. RVLSS in each segment was compared between SSc and C using a Student’s t test. We modeled RVLSS as a function of segment and disease group (SSc vs. C). T-test was used to compare the group difference, and GEE to account for clustering of RV strain values across the 3 RV segments.
Results: Global RVLSS was diminished in SSc compared to C (β 1.5, p=0.045). Regional differences in RVLSS were also noted: decreased in the apex (SSc -8.5 vs C -17.2, p<0.0001) and mid (SSc -12.4 vs. -17.8, p<0.0001) segments and increased in the base (SSc -32.2 vs. C -22.5, p<0.0001) in SSc vs C. Among C, regional differences in RVLSS were detected in the basal segment relative to the apex (base-apex β -5.4; p<0.0001) but not in the mid-apex comparison. In contrast, SSc had significant regional differences throughout (base-apex β -23.6, mid-apex β -3.9, both p<0.0001), especially when comparing the basal to apical segments. The base-apex difference was significantly greater in SSc compared to C (p<0.0001 for interaction). While SSc had a higher mean PASP than C (SSc 31.4 vs C 22.7 mmHg, p=0.0001), the differences observed in regional strain between SSc and C were unchanged when restricting our analyses to those with a PASP<35 mmHg.
Conclusion: In SSc patients, basal segments of the RV free wall had increased RVLSS, in comparison to mid and apical segments, and the base-apex difference with significantly higher than that seen in non-scleroderma controls. This heterogenous pattern of regional strain in SSc patients, regardless of PASP, suggests regional remodeling of the RV prior to the onset of overt RV dysfunction.
Author Disclosures: M. Mukherjee: None. S. Chung: None. L.K. Hummers: None. F.M. Wigley: None. T.P. Abraham: None. A.A. Shah: None.
- © 2014 by American Heart Association, Inc.