Introduction: Cardiac involvement in scleroderma (SSc) includes pulmonary hypertension, myocardial fi-brosis and subclinical systolic dysfunction, but the long term influence of current rheumatological therapies on those features has to be investigated.
Objective: To assess 2D and 4D parameters of systolic function, as well as arterial stiffness in patients with di-fferent forms of SSc and to determine their long term evolution under standard therapy.
Methods: 60 subjects with SSc were studied at baseline. Of those, 52 were reassessed after 1 year and 30 after 2 years of treatment. Standard 2D echocardiography was used for LV ejection fraction (2DEF), RV fracti-onal area shortening (FAC), TAPSE and systolic pul-monary artery pressure (sPAP). Tissue Doppler was used for systolic velocities at the tricuspid annulus (S TDI). Speckle tracking was used to determine LV 2D longitudinal (2DLS), circumferential (2DCS), radial (2DRS) strain and RV longitudinal strain (RVGLS). Also, 4D auto LV quantification echo was used to assess 4D ejection fraction (4DEF), and longitudinal (4DLS), circumferential (4DCS), radial (4DRS), and area strain (4DAS). Cardio-ankle vascular index (CAVI) and an-kle-brachial index (ABI) were used to determine arte-rial stiffness.
Results: At baseline, standard echo parameters were normal. As we have already shown, SSc patients have subclinical systolic dysfunction compared to age, sex and cardiovascular risk factors matched normal. Af-ter 1 year and similarly after 2 years of treatment, 2D standard, TDI and speckle tracking echo parameters, as well as 4D echocardiography and arterial stiffness parameters, were similar to baseline, with no corre-lation to the treatment type (2DEF% 57.3±6.8 at ba-seline vs. 57.1±5.4 at 1 year and 58.2±4.4 at 2 years; 2DLS% -16.9±2.7 vs. -18.0±2.2 and -17.3±3.2; 4DEF% 61.3±6.5 vs. 62.8±6.1 and 62.8±6.1; 4DLS% -11.7±4.2 vs. -13.2±3.4 and -11.9±4.3; 4DAS% -21.2±6.3 vs. -19.4±12.7 and -21.3±7.4; sPAP mmHg 26.0±10.3 vs. 29.4±10.9 and 26.0±7.5; RVGLS% -21.0±5.1 vs. -19.6±5.0 and -19.2±2.0; CAVI 7.8±1.0 vs. 7.6±1.6 and 7.5±1.3; for all parameters p=NS).
Conclusions: Patients with scleroderma have subclini-cal systolic dysfunction which doesn’t seem to be influ-enced by classical therapy, suggesting that cardiovascu-lar screening and prevention in these patients should be implemented extensively.