Comprehensive noninvasive assessment of cardiac involvement in limited systemic sclerosis

Abstract

Objective. To assess cardiovascular abnormalities in patients with limited systemic sclerosis (SSc), using noninvasive cardiac techniques.Methods. Sixty‐three patients with limited SSc were prospectively evaluated with Doppler echocardiography and thallium‐201 perfusion scintigraphy after a cold‐stress test and radionuclide ventriculography.Results. In the patients with limited SSc, there was a significantly high prevalence of abnormal left‐ and right‐diastolic function parameters (P = 0.001 and P = 0.0002, respectively), thickening of papillary muscles (46%; P = 0.003), and mild mitral regurgitation (49%; P < 0.0001), compared with controls. Systolic pulmonary arterial hypertension was detected in 9 patients (14%), and pericardial effusion in 11 patients (18%). In 64% of patients with limited SSc, an ischemic response was detected on the thallium cold‐stress scan; similarly, an ischemic response was detected in 57% of patients with primary Raynaud's phenomenon (P < 0.0001 versus controls).Conclusion. Although the frequency of cardiovascular symptoms was low in patients with limited SSc, a significant rate of cardiovascular abnormalities was found by noninvasive cardiac techniques.

Isolated right ventricular dysfunction in systemic sclerosis: latent pulmonary hypertension?

“…Systemic sclerosis is also frequently complicated by pulmonary hypertension (PH). An increase in pulmonary artery pressure has been reported in 5-50% of patients [2], and is associated with poor prognosis and identified as a cause of altered diastolic function of both right and left ventricles (RV and LV, respectively) [2][3][4][5][6].…”

High Ischemia-Modified Albumin Concentration Reflects Oxidative Stress But Not Myocardial Involvement in Systemic Sclerosis

“…In SSc, vasospasm causes frequent episodes of reperfusion injury and free-radicalmediated endothelial disruption. Primary myocardial involvement is far more common than initially suspected on clinical grounds (1)(2)(3)(4)(5) and affects survival rates because it is associated with a poor prognosis (6,7 ). Myocardial fibrosis is thought to occur secondarily to repeated focal ischemia in the coronary microcirculation as a result of abnormal vasoreactivity, with or without associated structural vascular disease (4,5 ).…”

“…Although both methods are useful, the STR assay has been increasingly used because fluorescence in situ hybridization can be used only in cases with specific genetic aberrations or a sexmismatched donor (2)(3)(4). The STR assay, which produces quantitative results within 1 day, uses fluorescence-labeled primers and a capillary electrophoresis system (5,6 ). However, the precision of the assay's performance with respect to the chimeric stages of hematopoietic cells has not been fully investigated.…”

Diagnosis and treatment of systemic and localized scleroderma

“…Cardiac involvement is often present, but rarely clinically significant. Myocardial perfusion scintigraphy, ventriculography and echocardiography are the most sensitive techniques for diagnosis [12]. Electrocardiographic abnormalities seen are conduction system disturbances, signs of infarction and nonspecific ST and T-wave changes.…”