Asymptomatic left ventricular diastolic dysfunction in diffuse systemic sclerosis patients: conventional echocardiography and left atrial speckle tracking

Our objective was to assess asymptomatic left ventricular diastolic dysfunction (LVDD) in diffuse systemic sclerosis (SSc) patients using both conventional and two-dimensional speckle tracking echocardiography in correlation to disease variables. Twenty-two patients with diffuse SSc without symptoms of LVDD and 22 controls were included in a comparative cross-sectional study. Skin fibrosis was assessed by modified Rodnan skin thickness score and disease severity by Medsger’s score. Parameters related to diastolic functions of the left ventricle were obtained by conventional echocardiography. Assessment of left atrium (LA) functions was by two-dimensional speckle tracking echocardiography as a predictor of LVDD. There were significant differences between patients and controls regarding E-wave deceleration time (194.8±27.3 vs. 157.1±20.3; P <0.001), E/E’ (8.85±1.98 vs. 6.99 ±0.69; P =0.008), positive peak LAɛ (11.4±2.9 vs. 18.8±2.28; P <0.001), and sec. positive peak LAɛ (17.5±3.9 vs. 25.5±2.7; P <0.001). All LA strain parameters were significantly correlated with disease duration, disease severity, N-terminal pro b-type natriuretic peptide, E/E’, and E-wave deceleration time, while positive peak LAɛ was correlated with the modified Rodnan skin thickness score. Receiver operating characteristic curve analysis identified a positive peak value of less than or equal to 10.8 and sec. positive peak of less than or equal to 17.5 as predictors for the detection of E/E’ more than or equal to 8. LA reservoir and conduit functions were significantly affected in SSc patients than controls and were associated with longer disease duration and more severe disease, while only reservoir function was associated with more fibrotic skin changes. All LA strain parameters correlated significantly with E/E’ ratio, while positive peak LA and sec. positive peak LA were demonstrated as LVDD predictors in patients with diffuse SSc.