Right heart function by 3D-echocardiography and 2D-speckle tracking in scleroderma patients in absence of pulmonary hypertension

Purpose: Systemic Sclerosis (SSc) involves the right heart (RH) with the appearance of pulmonary hypertension (PH). Whether SSc can directly affect RH function in absence of PH is unknown. Recently, 3D-echocardiography (3DE) and 2D-speckle tracking (2D-STE) have been validated to assess heart chamber function and mechanics. Therefore, we used3DEand 2D-STE to assess right ventricular (RV) andright atrial (RA) function in patients with SSc without PH. Methods: 34 SSc patients without PH were compared with 34 age and gender-matched healthy volunteers. All subjects underwent a complete echocardiogram, including 3DE RV volumes and ejection fraction (EF) and global RV and RA longitudinal strain (Ls) by 2D-STE. Results: SSc patients demonstrated similar RV size with lower RV function but no differences about RV global Ls (p=NS) (Table). Pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance (PVR) were higher in SSc patients (Table). RA appeared larger in patients, but with lower active contraction (RA-LsNeg). At bivariate analysis, PVR was inversely correlated with RV EF (r=-0.34, p= 0.008) and RA-LsNeg (r= -0.27, p=0.04) and directly correlated with RA maximum volume increase (r=0.31,p=0.012). Conclusions: a slightly increased afterload in SSc patients appared to be associated to an impairment of RV pump function, with normal RV myocardial mechanics, paralleled by an increase of RA volume with an impairment of RA active myocardial contraction.