Myocardial work in a cohort of systemic sclerosis patients

Introduction: Myocardial strain analysis provides im-portant information on cardiac performance adding to standard parameters of left ventricular (LV) systolic function. Myocardial work (MW) is emerging as an al-ternative tool for studying LV systolic function, becau-se it isn’t influenced by changes in afterload that could alterate strain analysis. Systemic sclerosis (SSc) is an autoimmune disease frequently associated with myo-cardial fibrosis determining diastolic and subclinical systolic dysfunction.

Objective: To assess parameters of myocardial work in patients with SSc and in age and cardiovascular risk factors matched controls.

Methods: 60 subjects (51 ± 9 years, 53 women) were studied: 40 patients with SSc (75% limited, 25% gene-ralized form, mean time since onset 5 ± 4 years, mean time since treatment start 2.5 ± 0.5 years), and 20 age and cardiovascular risk factors matched controls. A comprehensive echocardiographic examination was performed. Myocardial work parameters were calcu-lated during mechanical systole and isovolumetric re-laxation (IVR), by 2DSTE: global constructive work (GCW), performed during shortening in systole adding negative work during lengthening in IVR; global was-ted work (GWW), performed during lengthening in systole adding work performed during shortening in IVR; global work efficiency (GWE), as the GCW divi-ded by (GCW+GWW) and global work index (GWI), as the GCW added to GWW.

Results: 2DEF (61.3 ± 6.5% in SSc vs. 60.4 ± 8.7% in controls), 2D longitudinal strain (22.9 ± 3.4% vs. 22.41%), GWW (81.0 ± 51.3 mmHg% vs. 73.5 ± 38.9 mmHg%,) GWE (95.0 ± 2.8 vs. 95.9 ± 2.1 mmHg%) and GWI (1869.9 ± 410.9 mmHg% vs. 2023.2 ± 321.7 mmHg%) were similar in both groups (p=NS for all pa-rameters), with values expected for sex and age. GCW was significantly lower in SSc patients (2124.2 ± 449.5 mmHg% vs. 3102.8 ± 337.5 mmHg%, p=0.02).

Conclusions: Patients with treated SSc have lower myocardial constructive work (GCW) compared to matched controls, probably due to subtle myocardial fibrosis, persisting under adequate treatment. Longer follow up and larger cohorts are needed in order to es-tablish the role of MW analysis in the serial assessment of patients with SSc at risk of developing overt cardio-vascular disease.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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