Speckle-tracking global longitudinal strain predicts death and cardiovascular events in patients with systemic sclerosis

Abstract

Aims Albeit often asymptomatic, heart involvement in systemic sclerosis (SSc) represents a negative prognostic factor, accounting for nearly one-fourth of all deaths. Global longitudinal strain (GLS) is accurate in detecting heart involvement in patients with SSc and no overt cardiac disease and allows early detection and longitudinal monitoring, but its association with clinical endpoints has not been tested so far. The primary outcome was the association between left and right GLS and mortality for all causes. The secondary outcome was the association between left and right GLS and hospitalizations. Methods and results prospective longitudinal study enrolling all consecutive SSc patients without structural heart disease or previous cardiovascular event. A total of 164 patients were enrolled, of which 19 (11.5%) died during follow-up, while 48 (29.3%) were hospitalized. Both left and right ventricle GLS at enrolment were independently associated with an increased risk of death for all causes and hospitalizations. Patients with biventricular GLS impairment respectively had a 4.2-fold, 4.9-fold, and 13.9-fold increased risk of death when compared with patients with only LV, only RV, or no impairment (p<0.001). Incidence of hospitalization in patients with biventricular GLS impairment was nearly four times higher when compared with patients with only LV or only RV impairment, and nine times higher when compared with normal biventricular GLS (p<0.001). Conclusion Biventricular GLS is associated with an increased risk of death and hospitalization in patients with SSc during a median of 3-year follow-up, acting as a reliable and accurate prognostic tool in everyday practice.

Left Ventricular Twist and the “Rigid Body Rotation” Pattern in Patients Treated with Anthracyclines or Anti-HER2

“…It is also important to bear in mind the preload dependency of this measurement. Moreover, the heart has significant cardiac reserve, and the expression of damage in the form of alterations in systolic or diastolic parameters may not be apparent until a substantial amount of cardiac reserve has been exhausted [ 14 , 15 ]. This is why LVEF reduction is often a delayed phenomenon of cardiotoxicity [ 6 ].…”