Impact of myocardial fibrosis on left ventricular diastolic function in patients with systemic sclerosis

Introduction: Patients with systemic sclerosis have a high prevalence of myocardial fibrosis, which has a potential negative impact on cardiac function. Diastolic dysfunction is a frequent echocardiographic finding in patients with scleroderma. The aim of this study was to evaluate the possible influence of myocardial fibrosis on the diastolic function of the left ventricle in patients with systemic sclerosis. Material and methods: Twenty seven patients with diffuse or limited cutaneous scleroderma underwent transthoracic echocardiography using Doppler and tissue Doppler parameters for diastolic function assessment and cardiac delayed-enhancement magnetic resonance imaging (DE-MRI) for myocardial fibrosis identification and characterization. Results: The prevalence of diastolic dysfunction was 22.2% and of myocardial fibrosis 81.4%. All patients with diastolic dysfunction had impaired relaxation of the left ventricle. There was a statistically significant correlation between the presence of diastolic dysfunction and the number of left ventricular segments affected by myocardial fibrosis (r = 0.405, P = 0.036), and between the amplitude of Am wave and the presence of endocardial fibrosis. When compared according to the presence or absence of diastolic dysfunction, patients with diastolic dysfunction had a significantly higher number of LV segments affected by myocardial fibrosis (4.25 ± 3.25 vs. 3 ± 3, P = 0.044). The presence of an increased E/Em ratio (value > 6) had a sensitivity of 32% and a specificity of 100% in predicting the presence of myocardial fibrosis at DE-MRI (area under the curve = 0.689). Conclusion: Myocardial fibrosis is frequently encountered among scleroderma patients. Its presence is associated with diastolic dysfunction of the left ventricle.