Unique Abnormalities in Right Ventricular Longitudinal Strain in Systemic Sclerosis Patients

Circ Cardiovasc Imaging. 2016 Jun;9(6):10.1161/CIRCIMAGING.115.003792 e003792. doi: 10.1161/CIRCIMAGING.115.003792. Epub 2016 Jun 7.


Background: Cardiac involvement in systemic sclerosis (scleroderma [SSc]) adversely affects long-term prognosis, often remaining undetectable despite close clinical examination and 2-dimensional echocardiographic monitoring. Speckle-derived strain of the right ventricle (RV) was utilized to detect occult abnormalities in regional and global contractility in SSc patients.

Methods and results: A total of 138 SSc patients with technically adequate echocardiograms was studied and compared with 40 age- and sex-matched healthy non-SSc controls. Standard assessment of RV chamber function included tricuspid annular plane systolic excursion and fractional area change. RV longitudinal systolic speckle-derived strain was assessed in the basal, mid, and apical free wall. Tricuspid annular plane systolic excursion was not different between groups (P=0.307). Although fractional area change was lower in SSc patients than in controls (mean, 48.9 versus 55; P=0.002), the mean fractional area change was still within the normal range (>35). In contrast, RV longitudinal systolic speckle-derived strain measures were significantly different between groups, both globally (-20.4% versus -17.7%; P=0.005) and regionally: they were decreased in the apex (-8.5% versus -17.1%; P<0.0001) and mid segments (-12.4% versus -20.9%; P<0.0001), and increased in the base (-32.2% versus -23.3%; P=0.0001) for the SSc group. The regional difference in the base compared with the apex was significantly greater for SSc than for controls (P<0.0001 for interaction). The differences observed in regional strain between SSc and control were unchanged after adjusting for RV systolic pressure.

Conclusions: Speckle-derived strain reveals a heterogenous pattern of regional heart strain in SSc that is not detected by conventional measures of function, suggestive of occult RV myocardial disease.

Keywords: cardiomyopathies; heart ventricles; hypertension, pulmonary; scleroderma, systemic; ventricular function, right.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Biomechanical Phenomena
  • Cardiomyopathies / diagnostic imaging*
  • Cardiomyopathies / etiology
  • Cardiomyopathies / physiopathology
  • Echocardiography / methods*
  • Female
  • Fibrosis
  • Humans
  • Hypertension, Pulmonary / etiology
  • Hypertension, Pulmonary / physiopathology
  • Male
  • Middle Aged
  • Myocardial Contraction*
  • Myocardium / pathology
  • Observer Variation
  • Predictive Value of Tests
  • Reproducibility of Results
  • Retrospective Studies
  • Risk Factors
  • Scleroderma, Systemic / complications*
  • Scleroderma, Systemic / diagnosis
  • Stress, Mechanical
  • Tricuspid Valve / diagnostic imaging
  • Tricuspid Valve / physiopathology
  • Ventricular Dysfunction, Right / diagnostic imaging*
  • Ventricular Dysfunction, Right / etiology
  • Ventricular Dysfunction, Right / physiopathology
  • Ventricular Function, Right*