Clinical assessment of cardiac impairment favored by two-dimensional speckle tracking echocardiology in patients with systemic sclerosis

Abstract

Background Cardiac involvement is a major cause of death in systemic sclerosis (SSc), while early detection remains a challenge. Objectives The purpose of this study was to investigate the prevalence and clinical implications of cardiac impairment in SSc. Methods 95 consecutive SSc patients (55.6 ± 13.8 years old, 5.3 ± 8.1 years from diagnosis) were included in the study. Patients with heart diseases onset prior to SSc were excluded. All patients underwent two-dimensional speckle-tracking echocardiology (2D-STE) with measuring left and right ventricular global longitudinal strain (GLS/RGLS). Clinical manifestation, laboratory evaluation (CRP, cTnI, antibodies, etc.) and ECG were collected at the same time. Comparisons between the SSc subgroups (lcSSc and dcSSc) were performed using Student’s t test, Mann–Whitney U or Fisher’s exact test. Binary logistic regression was applied to determine the independent effects of variables in cardiac impairment. Results Early left and right ventricular impairment measured by GLS and RGLS were detected in 22.1% and 24.2% of the SSc patients, respectively. In comparison, only 2.1% showed reduced left ventricular ejection fraction (LVEF). Impaired GLS was mainly observed in the basal and medial segments of anterior, lateral, and posterior left ventricle walls, and more profound in dcSSc. Elevated CRP (OR 3.561 95% CI (1.071–11.839), p< 0.05) was associated with reduced GLS/RGLS. The adoption of GLS/RGLS enhanced the efficacy of routine screening for cardiac impairment that 52.6% of patients showed potential cardiac impairment. Conclusions Cardiac impairment is a common manifestation in SSc. Increasing awareness of early cardiac impairment is warranted with elevated CRP and dcSSc.

Biomarkers in the evaluation of cardiac involvement in systemic sclerosis

“…[ 39 ] 2020 47 SSc patients vs 36 healthy controls CRP, Galectin-3 CRP and Galectin-3 correlated with PSS Jiang, et al . [ 40 ] 2022 95 SSc patients CRP CRP associated with reduced GLS Rodriguez-Reyna, et al . [ 42 ] 2015 62 SSc patients CRP CRP associated with myocardial fibrosis on cMRI Gieszczyk, et al .…”

“…Studies have shown a correlation between CRP and ventricular impairment measured through echocardiographic longitudinal strain, which is a more sensitive marker of left ventricular dysfunction before overt reduction in LVEF. [ 39 , 40 ] Studies looking at myocardial inflammation and fibrosis using cMRI have similarly demonstrated a correlation with CRP levels. [ 41 , 42 ] Higher levels of CRP are associated with reduced 5-year survival in SSc patients, particularly with interstitial lung disease (ILD).…”