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

Abstract

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.

Unique Abnormalities in Right Ventricular Longitudinal Strain in Systemic Sclerosis Patients

“…In addition to intrinsic heart disease, there is unique vascular insult of the systemic and pulmonary vascular beds, each of which adversely affects long-term prognosis. 1-3 Development of pulmonary arterial hypertension (PAH) in particular has a strong correlation with reduced mortality, with 50% 3-year survival rates in patients with NYHA Class II at the time of diagnosis. 4-7 …”

Speckle Tracking Echocardiography Detects Uremic Cardiomyopathy Early and Predicts Cardiovascular Mortality in ESRD

“…This was shown even in the setting of special patient cohorts. [12][13][14][15] Because it does not depend on the Doppler angle, as in tissue Doppler imaging, it allows assessment of strain and strain rate analyses in different myocardial axes (i.e., longitudinal, circumferential, and radial). STE has been used to gain further insight into the pathophysiology of cardiac ischemia and infarction, and several primary diseases of the myocardium, such as hypertrophic or diabetic cardiomyopathy.…”

Longitudinal Strain by Automated Function Imaging Detects Single-Vessel Coronary Artery Disease in Patients Undergoing Dipyridamole Stress Echocardiography

“…[15][16][17][18] In this respect, the application of new technologies in improving the accuracy of stress echocardiography to diagnose CAD, by overcoming the limitation of subjective myocardial WM assessment depending on operator experience and technical skills, in recent years appeared particularly promising. This applies primarily to DipSE, which is affected by lower diagnostic accuracy in single-vessel CAD than other stressors, including dobutamine and exercise, which are currently preferentially used as first-line methods to trigger myocardial ischemia.…”