276 Arterial stiffness and diastolic dysfunction in patients with systemic sclerosis

Abstract

s S33 Eur J Echocardiography Abstracts Supplement, December 2006 276 Arterial stiffness and diastolic dysfunction in patients with systemic sclerosis J. Bozo 1 ; R. Faludi 1 ; G. Kumanovics 1 ; L. Czirjak 1 ; A. Cziraki 1 ; T. Simor 1 ; L. Papp 1 1Univ. Pecs, Heart Institute, Faculty of Med., Pecs, Hungary Objectives: Vascular abnormalities are hallmarks of almost all systemic sclerosis patients. Impaired relaxation of the left ventricle is also characteristic for scleroderma heart disease. The aim of our study was to determine whether parameters of arterial stiffness correlate with echocardiographic indices of left ventricular relaxation impairment. Material: 21 patients with limited and diffuse scleroderma (18 women, mean age: 55±9 years) were studied. Methods: Parameters of local and systemic arterial stiffness (pulse wave velocity: PWV; augmentation index: Aix) were determined by automatic brachial pulse wave analysis (Arteriograph®). The same parameters and elastic modulus (Ep), stiffness index (s), arterial compliance (AC) were measured on left brachial and common carotid arteries by echo-tracking (Aloka ProSound 5500). Indices of diastolic function were also determined with the same ultrasound system: in addition to the conventional Doppler parameters of the transmitral flow early (E) and late (A) diastolic velocities, deceleration time (DT), isovolumic relaxation time (IVRT) myocardial early (Ea) and late (Aa) diastolic velocities were measured at the lateral border of the mitral annulus using tissue Doppler imaging. E/A and E/Ea ratios were calculated. Simple associations between the variables were estimated by Pearson’s method. Results: Carotid Ep showed significant correlations with both A (r=0.537, p<0.05) and E/A (r=-0.500, p<0.05) values, and correlated with IVRT also significantly (r=0.489, p<0.05). Carotid s correlated with A (r=0.479, p<0.05), E/A (r=-0.548, p<0.05) and IVRT (r=0.564, p<0.01). Carotid AC correlated with A (r=-0.512, p<0.05), E/A (r=0.551, p<0.05) and IVRT values (r=-0.436, p<0.05). Carotid PWV and Aix showed similarly significant correlations with A, E/A, IVRT and with A and E/A values, respectively. Ep, s and PWV determined by pulse-wave analysis and brachial artery echo-tracking did not correlate with the echocardiographic parameters of the left ventricular diastolic function. Brachial AC showed a significant correlation with A (r=-0.478, p<0.05) and DT (r=0.469, p<0.05). Significant correlation was found between Aix measured by pulse-wave analysis and Aa (r=0.560, p<0.05). Conclusion: Distensibility of elastic arteries correlates well with the echocardiographic indices of the left ventricular diastolic function, but stiffness of muscular type arteries is less useful to predict the degree of diastolic impairment. Selected parameters of arterial stiffness are good predictors of diastolic dysfunction in scleroderma patients ±. 277 Tissue Doppler analysis of regional myocardial dysfunction in patients with systemic sclerosis M. Hirata 1 ; A. Takagi 2 ; K. Shimamoto 3 ; S. Ihara 1 ; H. Watanabe 1 ; K. Mizuochi 1 ; M. Endou 1 ; M. Kawana 3 1Institute of Geriatrics, TWMU, Cardiology Dept., Tokyo, Japan; 2Tokyo Women’s Medical University Hospital, Cardiology Dept., Tokyo, Japan; 3TWMU Aoyama Hospital, Cardiology Dept., Tokyo, Japan Purpose: Systemic sclerosis (SSc) is a multi-system disorder characterized by connective tissue fibrosis resulting in poor cardiac prognosis. Tissue Doppler imaging (TDI) might be useful in early detection of regional myocardial dysfunction. The aim of this study is to estimate the early myocardial dysfunction in SSc patients by using TDI. Methods: Twenty patients with SSc without obvious wall motion abnormalities were compared to 25 age-matched control subjects. E/A ratio and deceleration time (DCT) of trnasmitral inflow were recorded. Peak systolic strain (A) and diastolic strain at the first 30% of diastolic duration (B) were measured on strain curve at midventricular septum. Strain diastolic index was calculated as (A-B)/A×100(%). Results: There was no difference between the two groups in E/A, DCT and peak systolic strain. In contrast, strain diastolic index in SSc was significantly lower than those of control (p<0.01) (Table 1). Conclusion: TDI derived strain diastolic index appeared to be useful in early detection of diastolic dysfunction in patients with SSc.