Left atrial phasic function and heart rate variability in patients with systemic sclerosis: A new part of the old puzzle

Tadić, Marijana; Zlatanović, Maja; Cuspidi, Cesare; Stevanović, Ana; Kocijancic, Vesna; Pavlović, Smiljana; Ćelić, Vera

doi:10.1111/echo.13648

Cited by 5 publications

(5 citation statements)

References 38 publications

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“…Tigen et al 27 have reported that LA reservoir and conduit functions were similar between the groups, but other studies have reported one or more decreased LA mechanics indexes. [28][29][30][31] The present meta-analysis showed that εR and εCD were decreased, whereas no significant differences were found for εCT. For RA, εR was also confirmed to be decreased.…”

Section: Discussioncontrasting

confidence: 61%

“…Speckle tracking index for evaluation of atrium mechanics includes εR, εCD and εCT. Tigen et al 27 have reported that LA reservoir and conduit functions were similar between the groups, but other studies have reported one or more decreased LA mechanics indexes 28–31. The present meta-analysis showed that εR and εCD were decreased, whereas no significant differences were found for εCT.…”

Section: Discussioncontrasting

confidence: 48%

“…The duplicate records (66) were excluded. Additionally, articles that did not provide useful data were excluded, including conference abstracts (119), reviews (19), basic research studies (1), case reports, editorials, notes and surveys (11), non-relevant records (30), as well as studies not written in English language (2). The remaining 48 studies were further evaluated based on fulltext articles, of which 17 articles were excluded due to insufficient data.…”

Section: Literature Search and Study Selectionmentioning

confidence: 99%

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Cardiac involvement assessment in systemic sclerosis using speckle tracking echocardiography: a systematic review and meta-analysis

Qiao

Wang

et al. 2023

BMJ Open

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ObjectivesCardiac involvement in patients with systemic sclerosis (SSc) is associated with poor prognosis. Early detection of myocardial impairment is essential for treatment. The present study aimed to systematically review the value of detecting subclinical myocardial impairment in SSc patients using myocardial strain obtained from speckle tracking echocardiography (STE).DesignA systematic review and meta-analysis.Data sourcesThe PubMed, Embase and Cochrane library databases were searched in the period from the earliest available indexing date to 30 September 2022.Eligibility criteria for selecting studiesStudies evaluating myocardial function in SSc patients comparison with healthy controls based on myocardial strain data obtained from STE were included.Data extraction and synthesisVentricle and atrium data on myocardial strain were extracted to assessing the mean difference (MD).ResultsA total of 31 studies were included in the analysis. Left ventricular global longitudinal strain (MD: −2.31, 95% CI −2.85 to –1.76), left ventricular global circumferential strain (MD: −2.93, 95% CI −4.02 to –1.84) and left ventricular global radial strain (MD: −3.80, 95% CI −5.83 to –1.77) was significantly lower in SSc patients than in healthy controls. Right ventricular global wall strain (MD: −2.75, 95% CI −3.25 to –2.25) was also decreased in SSc patients. STE revealed significant differences in several atrial parameters including left atrial reservoir strain (MD: −6.72, 95% CI −10.09 to –3.34) and left atrial conduit strain (MD: −3.26, 95% CI −6.50 to –0.03), as well as right atrial reservoir strain (MD: −7.37, 95% CI −11.20 to –3.53) and right atrial conduit strain (MD: −5.44, 95% CI −9.15 to –1.73). There were no differences in left atrial contractile strain (MD: −1.51, 95% CI −5.34 to 2.33).ConclusionSSc patients have a lower strain than healthy controls for the majority of STE parameters, indicating the presence of an impaired myocardium involving both the ventricle and atrium.

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Section: Discussioncontrasting

confidence: 61%

Section: Discussioncontrasting

confidence: 48%

Section: Literature Search and Study Selectionmentioning

confidence: 99%

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Cardiac involvement assessment in systemic sclerosis using speckle tracking echocardiography: a systematic review and meta-analysis

Qiao

Wang

et al. 2023

BMJ Open

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“…However, a recent meta-analysis revealed that SSc patients have a lower strain than healthy controls for the majority of STE parameters, supporting the presence of impaired myocardium involving both ventricles and atriums [46 ]. Tigen et al [47] reported that left atrial (LA) reservoir and conduit function was similar between the groups, but other studies have reported one or more decreased LA mechanics indices [48][49][50][51]. Although only two studies [51,52] were included in the evaluation of right atrium conduit (eCD), they both showed impaired right atrial (RA) mechanics with decreased eCD.…”

Section: Echocardiography: the Traditional Diagnostic Frontlinementioning

confidence: 99%

Diagnosis and management of primary heart involvement in systemic sclerosis

De Luca,

Matucci-Cerinic,

Mavrogeni

2023

Current Opinion in Rheumatology

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Purpose of review In systemic sclerosis (SSc) primary heart involvement (pHI) is frequent, even though often unrecognized due to its occult nature and to the lack of a specific diagnostic algorithm. The purpose of this review is to report the state of the art of the evidence in the current literature, as well as the overall diagnostic modalities and therapeutic strategies for primary heart involvement in SSc. Recent findings SSc-pHI is defined by the presence of cardiac abnormalities that are predominantly attributable to SSc rather than other causes and/or complications; it may be sub-clinical and must be confirmed through diagnostic investigations. Novel electrocardiographic analysis and cardiac magnetic resonance (CMR) with mapping techniques have been recently proposed, showing a great utility in the early identification of SSc-pHI and in the noninvasive characterization of myocardial tissue. Immunosuppressive therapy emerged as fundamental to curb myocardial inflammation, and recent preclinical and clinical data support the role of antifibrotic drugs to treat SSc-pHI. Summary our review will help clinicians to properly integrate the available diagnostic modalities for the assessment of SSc-pHI. The ultimate goal is to propose a feasible diagnostic algorithm for the early identification of patients with SSc-pHI, and a schematic therapeutic approach to manage SSc-pHI.

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“…Although SSc is a multisystemic condition, cardiopulmonary manifestations are responsible for up to 85% of mortality [ 2 ]. In the heart, all structures can be affected by SSc, leading to inflammation, oxidative stress, vascular damage, and fibrosis [ 3 ]. The main underlying mechanism seems to be impairment of the microcirculation, with abnormal vasoreactivity due to dysfunction of the autonomic nervous system (ANS) [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of cardiac autonomic control during the 6-min walk test in women with systemic sclerosis

de Oliveira Saraiva,

de Oliveira Farias,

Mesquita dos Santos

et al. 2023

BMC Res Notes

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Objective To evaluate the association between sympathovagal balance and exercise performance, as measured by the 6-min walk test (6MWT), in women with systemic sclerosis (SSc) without cardiac involvement. Results This was a cross-sectional study in which 69 women with SSc [median age 51 (40–63 years)] without cardiac involvement underwent the 6MWT. Throughout the 6MWT, heart rate variability (HRV) was assessed using dedicated software. Methods The median 6-min walking distance (6MWD) was 451 (392–498) meters, and 29 (42%) participants did not achieve 80% of the predicted value for healthy adults. Desaturation during the 6MWT (SpO2 ≤ 4%) was observed in 10.1% of participants. Significant correlations were observed between the 6MWD and the following HRV parameters: number of successive normal-to-normal RR interval differences > 50 ms (rs=-0.397, P = 0.013), low-frequency range (rs=0.374, P = 0.023), high-frequency range (rs=-0.372, P = 0.023), and parasympathetic nervous system index (rs=-0.342, P = 0.045). Conclusion In women with SSc, there is an interrelationship of the 6MWD with both vagal withdrawal and sympathetic hyperactivation. This relationship between autonomic imbalance and worse exercise performance might increase cardiovascular risk, even in patients without apparent cardiac involvement. Control of the heart by the autonomic nervous system may be a potential target for treating patients with SSc.

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Left atrial phasic function and heart rate variability in patients with systemic sclerosis: A new part of the old puzzle

Abstract: Left atrial (LA) phasic function, assessed by both volumetric and strain method, as well as cardiac autonomic nervous function is significantly deteriorated in SSc patients. Skin score and HRV indices correlate with LA phasic function parameters.

Cited by 5 publications

References 38 publications

Cardiac involvement assessment in systemic sclerosis using speckle tracking echocardiography: a systematic review and meta-analysis

Cardiac involvement assessment in systemic sclerosis using speckle tracking echocardiography: a systematic review and meta-analysis

Diagnosis and management of primary heart involvement in systemic sclerosis

Evaluation of cardiac autonomic control during the 6-min walk test in women with systemic sclerosis

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