The relationship between left ventricular deformation and heart rate variability in patients with systemic sclerosis: Two- and three-dimensional strain analysis

Tadić, Marijana; Zlatanović, Maja; Cuspidi, Cesare; Ivanović, Branislava; Stevanović, Ana; Kocijancic, Vesna; Celic, Vera

doi:10.1016/j.ijcard.2017.02.043

Cited by 16 publications

(10 citation statements)

References 30 publications

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“…In the same study, there was an inverse relationship between baseline autonomic dysfunction (assessed by the LF/HF ratio) and the effect of LLTS (assessed by the change in LLTS ratio), indicating that worse higher LF/HF ratios predict a greater decrease in LF/HF during LLTS, similar to our findings ( Figure 4B). Notably, a significant association between cardiac function, as assessed by GLS, and autonomic function, as assessed by HRV parameters, has been previously shown in patients with hypertension [41] and scleroderma [42]. Frequency domain, but not time domain parameters changed significantly with LLTS.…”

Section: Discussionmentioning

confidence: 71%

Autonomic Neuromodulation Acutely Ameliorates Left Ventricular Strain in Humans

Tran

Asad

Elkholey

et al. 2018

J. of Cardiovasc. Trans. Res.

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Low-level transcutaneous vagus nerve stimulation at the tragus (LLTS) is anti-adrenergic. We aimed to evaluate the acute effects of LLTS on left ventricular (LV) function and autonomic tone. Patients with diastolic dysfunction and preserved LV ejection fraction were enrolled in a prospective, randomized, double-blind, 2×2 cross-over study. Patients received 2 separate, 1hour sessions, at least 1 day apart, of active LLTS (20Hz, 1mA below the discomfort threshold) and sham stimulation. Echocardiography was performed after LLTS or sham stimulation to assess cardiac function. A 5-minute ECG was performed to assess heart rate variability (HRV). Twentyfour patients were enrolled. LV global longitudinal strain improved by 1.8±0.9% during active LLTS compared to sham stimulation (p=0.001). Relative to baseline, HRV frequency domain components (low frequency, high frequency and their ratio) were favorably altered after LLTS compared to sham stimulation (all p<0.05). We concluded that LLTS acutely ameliorates cardiac mechanics by modulating the autonomic tone.

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Section: Discussionmentioning

confidence: 71%

Autonomic Neuromodulation Acutely Ameliorates Left Ventricular Strain in Humans

Tran

Asad

Elkholey

et al. 2018

J. of Cardiovasc. Trans. Res.

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“…With 50% of patients having calcium channel blockers, in our study, both SSc in itself and calcium channel blockers can cause higher heart rate. A higher heart rate decreases the diastolic filling, and this could affect the volumes and function [31]. Lastly, diffuse fibrosis could stiffen the myocardium and leads to decrease the ventricular volumes, leading to increased LVEF.…”

Section: Discussionmentioning

confidence: 99%

CMR feature tracking in cardiac asymptomatic systemic sclerosis: Clinical implications

et al. 2019

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Background Impaired myocardial deformation has been sporadically described in cardiac asymptomatic systemic sclerosis (SSc). We aimed to study myocardial deformation indices in cardiac asymptomatic SSc patients using cardiac magnetic resonance feature tracking (CMR-FT) and correlate these findings to the phenotypic and autoimmune background. Methods Fifty-four cardiac asymptomatic SSc patients (44 females, 56±13 years), with normal routine cardiac assessment and CMR evaluation, including cine and late gadolinium enhancement (LGE) images, were included. SSc patients were compared to 21 sex- and age- matched healthy controls (17 females; 54±19 years). For CMR-FT analysis, a mid-ventricular slice for LV peak systolic radial and circumferential strain and a 4-chamber view for LV/RV peak systolic longitudinal strain were used. Results Twenty-four patients had diffuse cutaneous SSc and 30 limited cutaneous SSc. Thirteen patients had digital ulcers. Median disease duration was 3.6 years. LV ejection fraction was higher in SSc patients compared to controls (62±6% vs. 59±5%, p = 0.01). Four patients had no LGE examination; in the remaining patients LGE was absent in 74%, while 18% had RV insertion fibrosis and 8% evidence of subendocardial infarction. LV longitudinal strain differed in those with insertion fibrosis (-18.0%) and infarction (-16.7%) compared to no fibrosis (-20.3%, p = 0.04). Patients with SSc had lower RV longitudinal strain and strain rate compared to controls (p<0.001 and p = 0.01, respectively). All other strain and strain rate measurements were non-significant between patients and controls. Conclusions In cardiac asymptomatic SSc patients with normal routine functional indices, CMR-FT identifies subclinical presence of insertion fibrosis and/or myocardial infarction by impaired LV longitudinal strain. RV derived longitudinal indices were impaired in the patient group. CMR FT indices did not correlate to the patients’ phenotypic and autoimmune features.

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“…A majority of studies regarding cardiac involvement in SSc are focused on left and right ventricular (LV and RV) remodeling . There is little research that investigated left atrial (LA) changes in SSc patients and showed that LA remodeling is an important part of overall cardiac adjustment in SSc .…”

Section: Introductionmentioning

confidence: 99%