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

¹ Depts of Cardiology; and Pathophysiology, Hôpital Erasme, Université Libre de Bruxelles, Belgium
² Internal Medicine
³ Depts of Cardiology
⁴ Laboratory of Echocardiography, Hospital Louis Tradel, Lyon, France
⁵ Vascular diseases
⁶ Pathophysiology, Hôpital Erasme, Université Libre de Bruxelles, Belgium

^* To whom correspondence should be addressed. E-mail: rnaeije{at}ulb.ac.be.

	Abstract

Right ventricular function is frequently abnormal in patients with systemic sclerosis, but whether this is related to pulmonary vascular complications of the disease is unclear.

A standard echocardiography with tissue Doppler imaging was performed at rest and at exercise for the study of the right ventricular function and the pulmonary circulation in 25 consecutive systemic sclerosis patients and in 13 age-matched healthy controls.

As compared to the controls, the patients had no difference in systolic right ventricular pressure gradient, but a decreased pulmonary flow acceleration time, and increased right ventricular free wall thickness and end-diastolic dimensions. At the tricuspid annulus, the E maximal velocity was decreased (8.9±4 vs 11.7±2.3 cm·sec^-1; p=0.03) and isovolumic relaxation time corrected to RR interval was increased (6.5±2.9 vs 4.5±2.5%;p=0.03). The tissue Doppler imaging profile at the mitral annulus was similar in both groups. At exercise, the patients (n=18) had a decreased maximum workload and cardiac output, no change in systolic right ventricular pressure gradient, but an increase in the slope of pulmonary artery pressure/flow relationships.

These results suggest that patients with systemic sclerosis may present with latent pulmonary hypertension as a likely cause of right ventricular diastolic dysfunction, and revealed by stress echocardiography and tissue Doppler imaging.

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