Abstract 18803: Abnormal Right Ventricular Longitudinal Strain With Exercise Stress Echocardiography in Systemic Sclerosis
Introduction: Cardiac involvement in systemic sclerosis (SSc) is associated with increased morbidity and mortality, due to the development of right ventricular (RV) dysfunction and associated pulmonary arterial hypertension (PAH). Current screening tools are insufficent to detect early cardiac involvement in SSc. We sought to assess the utility of exercise bicycle echocardiography (BE) in conjunction with speckle derived strain to detect occult abnormalities in regional and global RV contractility in SSc patients at high risk of PAH.
Methods: SSc patients were referred for supine BE. Inclusion criteria included: RV systolic pressure (RVSP) ≥40mmHg with dyspnea, RVSP ≥45mmHg regardless of symptoms, isolated decline in diffusing capacity (DLCO) ≥10% predicted from baseline, or new onset unexplained dyspnea. Patients initiated exercise at 25 Watts and increased by 25 watts every 3 minutes until achieving 85% of the their age-predicted maximum heart rate or were limited by symptoms. Standard 2D assessment of RV included baseline linear dimensions, and tricuspid annular plane systolic excursion (TAPSE), and RV fractional area change (FAC) at rest and stress. RV longitudinal systolic speckle-derived strain (RVLSS) was assessed in the base, midventricular and apex.
Results: 57 SSc patients with technically adequate echocardiograms were studied. While RV FAC significantly decreased with exercise (p<0.0001), there was no clinically significant difference in TAPSE. At rest, there was a heterogeneous pattern of RVLSS with hyperkinesis of the base (-27.3 ± 8.36%) and hypokinesis of the midventricular (-17.0 ± 4.87%) and apex (-12.04 ± 6.02%). With exercise, there was augmented contractility of all 3 regions in SSc patients with resting RVSP < 35 mmHg. However in SSc patients with RVSP ≥ 35 mmHg, augmentation of all 3 regions was diminished.
Conclusions: Speckle-derived strain reveals a heterogenous pattern of regional contractility of the RV free wall in SSc. In patients with normal resting RVSP, there was augmentated contractility with exercise. However in those with baseline elevation in RVSP, there was diminished contractility with exertion suggestive of occult regional myocardial dysfunction that is not detected by conventional measures.
Author Disclosures: M. Mukherjee: None. S.A. Mayer: None. R.J. Tedford: None. S.C. Mathai: None. L.K. Hummers: None. F.M. Wigley: None. T.P. Abraham: None. A.A. Shah: None.
- © 2016 by American Heart Association, Inc.