Early detection of cardiac involvement in systemic sclerosis assessed by tissue-Doppler echocardiography

Abstract

Cardiologia CROATICA Background: To assess cardiac involvement in SSc patients and to explore the relationship between interleukin (IL)-6 levels and echocardiographic abnormalities, and NTproBNP levels in SSc patients and to correlate tested parameters with disease activity (EUSTAR) score. Methods: This case-control study included 31 SSc patients with preserved left ventricular ejection fraction (LVEF) and no concomitant disease, and 32 matched healthy controls. Serum IL-6 and NT-proBNP levels were measured and subjects were evaluated by conventional and pulsed-wave tissue Doppler echocardiography. Results: SSc patients had significantly lower values of LV systolic (7.7 vs 9.25 cm/s, P<0.001) and early diastolic (8.7 vs 10.3 cm/s, P=0.014) myocardial velocities and higher E/e’ ratio (9.04 vs 7.37, P=0.001), although there was no between-group difference according to LVEF (68 vs 65%, P=0.248) and E/A ratio (1 vs 1.11, P=0.312). 18 SSc patients had LV systolic dysfunction (septal s’ <7.5 cm/s) versus 5 control subjects (P=0.010). According to the ASE recommendations, 18 SSc patients and 9 controls had LV diastolic dysfunction (P=0.032). IL-6 level showed correlation with LV mean e’ (r=-0.57, P=0.001) and E/e’ ratio (r=0.55, P=0.001). Also, IL-6 level significantly correlated with the presence (r=0.46, P=0.010) and severity (r=0.54, P=0.002) of LVDD and NT-proBNP level (r=0.52, P=0.003) in the SSc group, whereas no correlation was observed in control group. EUSTAR score correlated with LV E/e’ (r=0.48, P=0.006), mean e’ (r=-0.67, P<0.001), mean s’ (r=-0.51, P=0.004), NT-proBNP (r=0.60, P<0.001) and IL-6 (r=0.79, P<0.001), and with LVSD presence (r=0.363, P=0.044), and LVDD presence (r=0.58, P=0.001) and severity (r=0.621, P<0.001). Correlation was also found between IL-6 level and EUSTAR-score (r=0.79, P<0.001) Conclusions: We showed that subclinical LV impairment is common in patients with SSc who have not already demonstrated cardiac involvement. Positive correlation between IL6 and EUSTAR score and their association with the echocardiographic abnormalities and NT-proBNP may open up new possibilities for the treatment of SSc cardiomyopathy.