Right ventricular diastolic function abormalities in patients with systemic sclerosis

ABSTRACT

Systemic sclerosis is a generalized disorder of connective tissue characterized clinically by thickening and fibrosis of the skin and by distinctive forms of involvement of internal organs, among which is the heart. Manifestations of scleroderma heart disease are quite variable, and often not seen until late in the course of the disease. This work aimed to assess the prevalence of right ventricular diastolic abnormalities in patients with systemic sclerosis and to investigate the relation to the clinical manifestations of the disease. Our study group included thirty four patients with systemic sclerosis [32 females and 2 males, their age ranged from 19 to 67yrs with a mean of 40.3 +/- 11.5yrs and a mean disease duration of 8.9 +/- 7.4yrs.] and thirty healthy subject who served as controls. All the study groups were subjected to full clinical evaluation and echo-Doppler study. Parameters of diastolic function included, E/A ratio and time velocity integrals of A wave and diastolic filling [TVI of A/TVI of DF]. Patients were diagnosed as having diastolic dysfunction when one or more of the two criteria were abnormal. Right ventricular diastolic abnormalities were found in 23 patients [67.65%] while left ventricular diastolic abnormalities were found in 11 patients [32.35%]. Seven patients had an ejection fraction below 60%, all had right ventricular diastolic dysfunction. There was a highly statistically significant difference between patients and control as regard tricuspid E/A [1.1 +/- 0.3 vs 1.3 +/- 0.2, p=0.0001] and tricuspid TVI of A/TVI of DF [0.4 +/- 0.1 vs 0.3 +/- 0, p=0.0001]. A significant correlation was found between right ventricular diastolic abnormalities and age of patients [the mean age of patients with abnormal diastolic function was 44.6 +/- 12 vs 35.4 +/- 8.8 for patients with normal diastolic function, p=0.017]. Right and left ventricular diastolic function abnormalities are common in patients with systemic sclerosis. Echocardiography should be recommended for all patients with systemic sclerosis even in asymptomatic patients especially in elderely