EXTENDED REPORTS Right ventricular diastolic abnormalities in systemic sclerosis. Relation to left ventricular involvement and pulmonary hypertension

Objectives—To investigate right ventricular diastolic function in systemic sclerosis (SSc) and its relation to clinical features of the disease. Methods—Seventy seven unselected SSc patients and 33 healthy subjects were submitted to echocardiography and echo Doppler study to assess left and right systolic as well diastolic function and to estimate maximal arterial systolic pulmonary pressure (PAP). In addition, the patients were investigated to define the SSc subset and the extent of skin and internal organ involvement. Results—An abnormal right ventricular filling, as expressed by an inverted tricuspidal (Tr) E/A ratio (Tr E/A ratio <1), was detected in 31 of the 77 SSc patients (40%) and in 0 of the 36 controls ( p<0.001 ). All the 31 patients with an inverted Tr E/A ratio were found to have a PAP > 30 mm Hg. Twenty resulted to have an inverted mitral (Mit) E/A ratio (Mit E/A ratio <1), indicating an abnormal left ventricular filling. In multiple regression analysis, Tr E/A ratio resulted to be independently correlated to both PAP (r= −0.35;p<0.003) and Mit E/A ratio (r=0.39;p<0.001). Conclusions—This study points out an impaired right ventricular filling in a significant percentage of SSc patients whatever the subset. This alteration is independently correlated to both PAP and left ventricular filling abnormalities. (Ann Rheum Dis 2000;59:94–98) Systemic sclerosis (SSc) is a multisystem disorder of connective tissue characterised by widespread vascular lesions and fibrosis of the skin and distinct internal organs. 2 Some authors 4 and we ourselves have pointed out an impaired left ventricular filling in a significant percentage of SSc patients in whom no other cause of altered diastolic function had been detected. Diastolic abnormalities in SSc are likely to depend on either myocardial fibrosis or myocardial ischaemia, or both. As myocardial fibrosis as well as small intramyocardial coronary vessel involvement are known to aVect both left and right ventricles in SSc, 8 an altered right ventricular filling is likely to occur in this disease. Nevertheless, such aspect has received little attention so far. In this study, we have investigated right ventricular diastolic function in SSc and its relation to clinical features of the disease.