Left ventricular myocardial ischemia in collagen disease associated with pulmonary hypertension

Salem, Sherine; Moghazi, Abdel A.

doi:10.1097/mnm.0b013e32834654f8

Cited by 6 publications

(6 citation statements)

References 23 publications

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“…Along with multiple reports of RV abnormalities in SSc, usually secondary to vascular and interstitial lung disease resulting into pulmonary hypertension [19,20], a primary LV involvement related to organic and functional alterations of microvasculature, including reduced coronary flow reserve, has been observed [21-24]; in support of these data, studies performed using single photon emission computerized tomography (SPECT) have shown multiple ventricular perfusion defects in the absence of coronary artery disease documented by angiography, particularly in patients with pulmonary hypertension [25,26]. Owing to this vasculopathy, a “patchy” myocardial fibrosis develops, with a distribution unrelated to coronary vessels territories [27-30], leading, as consequences, to multiple LV diastolic and systolic abnormalities including lower TDI velocities and impaired myocardial deformation [31,32].…”

Section: Discussionmentioning

confidence: 99%

Role of 2D strain in the early identification of left ventricular dysfunction and in the risk stratification of systemic sclerosis patients

Piccione

Zito

Bagnato

et al. 2013

Cardiovasc Ultrasound

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BackgroundSystemic sclerosis (SSc) is an autoimmune chronic disease characterized by diffuse fibrosis involving several organs, including heart. Aim of our study was to analyze left ventricular (LV) myocardial deformation, by use of 2D strain, in asymptomatic SSc patients with normal LV ejection fraction.MethodsWe enrolled 29 SSc patients (28 female, 65±4 years) and 30 controls (23 female, 64±2 years). Echocardiographic study with tissue Doppler imaging (TDI) and 2D strain analysis was performed; moreover, patients were submitted to a two-year follow-up for the occurrence of cardiovascular events.ResultsStandard echocardiographic parameters and TDI velocities were comparable between groups. LV longitudinal (LS) and circumferential (CS) strains were lower in patients than in controls (−13.1±4.8 vs −22.6±4.1, p < 0.001; -15.3±6.2 vs −20.4±5.6, p = 0.001), whereas radial strain (RS) was comparable between groups; moreover, a significant correlation of LS and CS with serum levels of Scl-70 antibodies was found (r = 0.74, p = 0.001; r = 0.53, p = 0.025). In addition, patients with cardiovascular events during follow-up showed a greater impairment of LS and CS (−10.3±2.5 vs −14.4±4.1, p = 0.015; -14.2±3.1 vs −20.1±1.6, p = 0.048) and higher values of Scl-70 antibodies serum levels (p = 0.047).ConclusionThe impairment of LV function, often subclinical, worsens prognosis of SSc patients, leading to increased risk of cardiovascular complications. 2D strain, allowing the early detection of LV abnormalities and the identification of patients at greater cardiovascular risk, may be a useful tool in order to provide a more accurate management of SSc patients.

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Section: Discussionmentioning

confidence: 99%

Role of 2D strain in the early identification of left ventricular dysfunction and in the risk stratification of systemic sclerosis patients

Piccione

Zito

Bagnato

et al. 2013

Cardiovasc Ultrasound

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“…It has already been described that the development of pulmonary fibrosis is associated with increased pulmonary vascular resistance [28]; however, in patients with RL this is a concomitant disorder and not the primary cause of exercise limitation. Moreover, it is not unusual for patients with SSc-associated pulmonary arterial hypertension to present with concomitant primary or secondary left heart disease [29,30,31]; thus the utilization of CPET is necessary for the differentiation between the PV, RL and LVD groups. PET CO 2 reflects the ability of the cardiopulmonary system to discard excessive carbon dioxide produced during exercise.…”

Section: Discussionmentioning

confidence: 99%

Phenotyping Exercise Limitation in Systemic Sclerosis: The Use of Cardiopulmonary Exercise Testing

Boutou¹,

Pitsiou²,

Siakka³

et al. 2016

Respiration

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Background: Exercise impairment is a common symptom of systemic sclerosis (SSc), a disorder which is frequently complicated by cardiopulmonary involvement. Objectives: This study's aims were: (a) to define the prevalence and the potential causes of limited exercise capacity and (b) to study potential differences in clinical, radiological and functional characteristics and blood serology among SSc patients with exercise limitation of different etiology. Methods: Prospectively collected data on SSc patients who had conducted full lung function testing, blood serology, thorax high-resolution computed tomography, Doppler echocardiogram and a maximal cardiopulmonary exercise testing (CPET) were retrospectively analyzed. Using a CPET algorithm, patients were characterized as having normal or subnormal exercise capacity (N), respiratory limitation (RL), left ventricular dysfunction (LVD) or pulmonary vasculopathy (PV). Group comparisons were conducted using either one-way ANOVA or the Kruskal-Wallis test. A p value <0.05 was considered significant. Results: The study population consisted of 78 patients (53.7 ± 13.7 years old; 10.3% male). PV was present in 32.1%, LVD in 25.6% and RL in 10.2%, while 32.1% of the patients constituted the N group. The presence of antisclero-70 antibodies, low anaerobic threshold and low peak exercise capacity measures could discriminate LVD from the other groups. Low end-tidal carbon dioxide pressure and its change from rest to anaerobic threshold could discriminate between the PV, LVD and N groups, while respiratory restriction along with ventilatory inefficiency indices could differentiate the RL group from the rest. Conclusions: The combined evaluation of CPET gas exchange patterns with baseline measurements could discriminate the causes of exercise limitation among SSc patients.

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“…However, patients did not undergo angiography, so sensitivity, specificity, and predictive values were not available. In the study of El-Shafie et al, 16 only one of six patients with LV segmental perfusion defects had CAD at angiography, for a positive predictive value of only 16%. This suggests that there remains much to be learned about the interpretation of MPI in PH patients.…”

Section: Next Stepsmentioning

confidence: 92%

“…PH had, at one point, been considered a contraindication to stress testing. 19 In patients with moderate degrees of PH, as in the study by El-Shafie et al, 16 patients may be able to exercise to an adequate hemodynamic end point. However, as PH becomes more pronounced, as in the group represented by Gomez et al, 12 this becomes less likely, and pharmacologic stress testing is necessary.…”

Section: Pharmacologic Stress Testing Using Selective A2a Receptor Agmentioning

confidence: 97%

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Pharmacologic stress myocardial perfusion imaging in patients with pulmonary hypertension: What do we know, and what remains to be learned?

Tosh

Nichols

2018

Journal of Nuclear Cardiology

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Left ventricular myocardial ischemia in collagen disease associated with pulmonary hypertension

Cited by 6 publications

References 23 publications

Role of 2D strain in the early identification of left ventricular dysfunction and in the risk stratification of systemic sclerosis patients

Role of 2D strain in the early identification of left ventricular dysfunction and in the risk stratification of systemic sclerosis patients

Phenotyping Exercise Limitation in Systemic Sclerosis: The Use of Cardiopulmonary Exercise Testing

Pharmacologic stress myocardial perfusion imaging in patients with pulmonary hypertension: What do we know, and what remains to be learned?

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