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Article: Left ventricular dysfunction assessed by speckle-tracking strain analysis in patients with systemic sclerosis: relationship to functional capacity and ventricular arrhythmias

TitleLeft ventricular dysfunction assessed by speckle-tracking strain analysis in patients with systemic sclerosis: relationship to functional capacity and ventricular arrhythmias
Authors
KeywordsCardiopulmonary exercise test
Cardiopulmonary function
Heart left ventricle ejection fraction
Heart left ventricle failure
Heart ventricle arrhythmia
Issue Date2011
PublisherJohn Wiley & Sons, Inc. The Journal's web site is located at http://www.interscience.wiley.com/jpages/0004-3591/
Citation
Arthritis & Rheumatism, 2011, v. 63 n. 12, p. 3969-3978 How to Cite?
AbstractObjective Systemic sclerosis (SSc) is a connective tissue disease characterized by vascular inflammation and fibrosis. Visceral involvement, including cardiac manifestations, can lead to severe clinical complications, such as congestive heart failure, arrhythmias, and sudden death. Conventional echocardiography parameters have limited sensitivity to detect subtle myocardial dysfunction in patients with SSc. The aim of this study was to assess, using novel speckle-tracking strain analysis, the presence of myocardial dysfunction in patients with SSc, and to investigate its relationship to functional capacity and ventricular arrhythmias. Methods A total of 104 patients with SSc (mean ± SD age 54 ± 12 years, 77% female) were included and underwent cardiopulmonary exercise testing, 24-hour electrocardiography (EKG) Holter monitoring, and transthoracic echocardiography. For comparison, 37 matched healthy control subjects were included. Results The total patient population consisted of 51 patients with limited cutaneous SSc and 53 with diffuse cutaneous SSc. Peak VO 2 was a mean ± SD 91 ± 20% predicted, and 28 patients had abnormal findings (ventricular tachycardia or ventricular ectopics >100/day) on EKG Holter monitoring. Patients with SSc, as compared with controls, had impaired global longitudinal and circumferential strains (mean ± SD -18.2 ± 1.8% versus -21.3 ± 1.7% and -18.2 ± 2.3% versus -21.3 ± 2.1%, respectively; each P < 0.01), but there was no difference in the left ventricular ejection fraction between patients and controls (mean ± SD 63.5 ± 7.2% versus 64.6 ± 4.4%; P = 0.20). In patients with SSc, global longitudinal and circumferential strains each correlated with the peak VO 2 (r = -0.46 and r = -0.41, respectively; both P < 0.01), and multivariate analysis confirmed the independent association of each strain measure with the peak VO 2. Compared to SSc patients with normal results on EKG Holter monitoring, SSc patients with abnormal results showed impaired global longitudinal strains (-18.5 ± 1.5% versus -17.1 ± 2.1%; P < 0.01) and circumferential strains (-18.7 ± 2.0% versus -17.3 ± 2.5%; P = 0.01), and each strain measure was independently associated with abnormal Holter findings. Conclusion Speckle-tracking strain analysis can detect subtle myocardial dysfunction in patients with SSc. Importantly, decreased global longitudinal and circumferential strains are associated with lower functional capacity and rhythm disturbances in patients with SSc. © 2011 by the American College of Rheumatology.
Persistent Identifierhttp://hdl.handle.net/10722/152751
ISSN
2015 Impact Factor: 8.955
2015 SCImago Journal Rankings: 3.206
ISI Accession Number ID
Funding AgencyGrant Number
Hong Kong Heart Foundation
St. Jude Medical
Boston Scientific
Biotronik
Bristol-Myers Squibb Medical Imaging
Edwards Life-sciences
GE Healthcare
Medtronic
Lantheus Medical Imaging
Funding Information:

Dr. Yiu's work was supported by the Hong Kong Heart Foundation.

References

 

DC FieldValueLanguage
dc.contributor.authorYiu, KHen_HK
dc.contributor.authorSchouffoer, AAen_HK
dc.contributor.authorMarsan, NAen_HK
dc.contributor.authorNinaber, MKen_HK
dc.contributor.authorStolk, Jen_HK
dc.contributor.authorVlieland, TVen_HK
dc.contributor.authorScherptong, RWen_HK
dc.contributor.authorDelgado, Ven_HK
dc.contributor.authorHomlan, ERen_HK
dc.contributor.authorTse, HFen_HK
dc.contributor.authorHuizinga, TWJen_HK
dc.contributor.authorBax, JJen_HK
dc.contributor.authorSchuerwegh, AJen_HK
dc.date.accessioned2012-07-16T09:47:32Z-
dc.date.available2012-07-16T09:47:32Z-
dc.date.issued2011en_HK
dc.identifier.citationArthritis & Rheumatism, 2011, v. 63 n. 12, p. 3969-3978en_HK
dc.identifier.issn0004-3591en_HK
dc.identifier.urihttp://hdl.handle.net/10722/152751-
dc.description.abstractObjective Systemic sclerosis (SSc) is a connective tissue disease characterized by vascular inflammation and fibrosis. Visceral involvement, including cardiac manifestations, can lead to severe clinical complications, such as congestive heart failure, arrhythmias, and sudden death. Conventional echocardiography parameters have limited sensitivity to detect subtle myocardial dysfunction in patients with SSc. The aim of this study was to assess, using novel speckle-tracking strain analysis, the presence of myocardial dysfunction in patients with SSc, and to investigate its relationship to functional capacity and ventricular arrhythmias. Methods A total of 104 patients with SSc (mean ± SD age 54 ± 12 years, 77% female) were included and underwent cardiopulmonary exercise testing, 24-hour electrocardiography (EKG) Holter monitoring, and transthoracic echocardiography. For comparison, 37 matched healthy control subjects were included. Results The total patient population consisted of 51 patients with limited cutaneous SSc and 53 with diffuse cutaneous SSc. Peak VO 2 was a mean ± SD 91 ± 20% predicted, and 28 patients had abnormal findings (ventricular tachycardia or ventricular ectopics >100/day) on EKG Holter monitoring. Patients with SSc, as compared with controls, had impaired global longitudinal and circumferential strains (mean ± SD -18.2 ± 1.8% versus -21.3 ± 1.7% and -18.2 ± 2.3% versus -21.3 ± 2.1%, respectively; each P < 0.01), but there was no difference in the left ventricular ejection fraction between patients and controls (mean ± SD 63.5 ± 7.2% versus 64.6 ± 4.4%; P = 0.20). In patients with SSc, global longitudinal and circumferential strains each correlated with the peak VO 2 (r = -0.46 and r = -0.41, respectively; both P < 0.01), and multivariate analysis confirmed the independent association of each strain measure with the peak VO 2. Compared to SSc patients with normal results on EKG Holter monitoring, SSc patients with abnormal results showed impaired global longitudinal strains (-18.5 ± 1.5% versus -17.1 ± 2.1%; P < 0.01) and circumferential strains (-18.7 ± 2.0% versus -17.3 ± 2.5%; P = 0.01), and each strain measure was independently associated with abnormal Holter findings. Conclusion Speckle-tracking strain analysis can detect subtle myocardial dysfunction in patients with SSc. Importantly, decreased global longitudinal and circumferential strains are associated with lower functional capacity and rhythm disturbances in patients with SSc. © 2011 by the American College of Rheumatology.en_HK
dc.languageengen_US
dc.publisherJohn Wiley & Sons, Inc. The Journal's web site is located at http://www.interscience.wiley.com/jpages/0004-3591/en_HK
dc.relation.ispartofArthritis & Rheumatismen_HK
dc.rightsArthritis & Rheumatism. Copyright © John Wiley & Sons, Inc.-
dc.subjectCardiopulmonary exercise test-
dc.subjectCardiopulmonary function-
dc.subjectHeart left ventricle ejection fraction-
dc.subjectHeart left ventricle failure-
dc.subjectHeart ventricle arrhythmia-
dc.subject.meshVentricular dysfunction, Left - epidemiology - physiopathology - ultrasonographyen_HK
dc.subject.meshScleroderma, Systemic - epidemiology - physiopathologyen_HK
dc.subject.meshRisk factorsen_HK
dc.subject.meshOxygen consumption - physiologyen_HK
dc.subject.meshMultivariate analysisen_HK
dc.subject.meshMiddle ageden_HK
dc.subject.meshMaleen_HK
dc.subject.meshHumansen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshExercise testen_HK
dc.subject.meshElectrocardiography, Ambulatoryen_HK
dc.subject.meshElectrocardiographyen_HK
dc.subject.meshEchocardiography, Doppler - methodsen_HK
dc.subject.meshCross-sectional studiesen_HK
dc.subject.meshComorbidityen_HK
dc.subject.meshCase-control studiesen_HK
dc.subject.meshArrhythmias, Cardiac - epidemiology - physiopathologyen_HK
dc.subject.meshAgeden_HK
dc.subject.meshAdulten_HK
dc.titleLeft ventricular dysfunction assessed by speckle-tracking strain analysis in patients with systemic sclerosis: relationship to functional capacity and ventricular arrhythmiasen_HK
dc.typeArticleen_HK
dc.identifier.emailYiu, KH: khkyiu@hku.hken_HK
dc.identifier.emailTse, HF: hftse@hku.hken_HK
dc.identifier.emailSchuerwegh, AJ: A.J.M.Schuerwegh@lumc.nl-
dc.identifier.authorityYiu, KH=rp01490en_HK
dc.identifier.authorityTse, HF=rp00428en_HK
dc.description.naturelink_to_OA_fulltext-
dc.identifier.doi10.1002/art.30614en_HK
dc.identifier.pmid22127711-
dc.identifier.scopuseid_2-s2.0-82455210463en_HK
dc.identifier.hkuros201291en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-82455210463&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume63en_HK
dc.identifier.issue12en_HK
dc.identifier.spage3969en_HK
dc.identifier.epage3978en_HK
dc.identifier.eissn1529-0131-
dc.identifier.isiWOS:000297458500038-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridSchuerwegh, AJM=6602979520en_HK
dc.identifier.scopusauthoridBax, JJ=35379683700en_HK
dc.identifier.scopusauthoridHuizinga, TWJ=16197605000en_HK
dc.identifier.scopusauthoridTse, HF=7006070805en_HK
dc.identifier.scopusauthoridHolman, ER=7006388037en_HK
dc.identifier.scopusauthoridDelgado, V=24172709900en_HK
dc.identifier.scopusauthoridScherptong, RW=24503755800en_HK
dc.identifier.scopusauthoridVlieland, TV=6508375223en_HK
dc.identifier.scopusauthoridStolk, J=16237515000en_HK
dc.identifier.scopusauthoridNinaber, MK=8532409700en_HK
dc.identifier.scopusauthoridMarsan, NA=23035780700en_HK
dc.identifier.scopusauthoridSchouffoer, AA=6504743298en_HK
dc.identifier.scopusauthoridYiu, KH=35172267800en_HK

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