A case of systemic sclerosis with worsened subclinical left ventricular systolic dysfunction after pacemaker implantation

Figures

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  Fig. 1. (A) Electrocardiogram 4 months before admission showing advanced atrioventricular block with escape beats. (B) Electrocardiogram after pacemaker implantation. (C) Electrocardiogram after upgrading to cardiac resynchronization therapy.

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  Fig. 2. Left ventricular longitudinal strain and Bull's eye mapping by two-dimensional speckle-tracking echocardiography at 16 months before admission, 10 months before admission, and on admission. The white dotted line shows GLS in each view. AP4CH, apical four-chamber view; APLAX, apical long-axis view; AP2CH, apical two-chamber view; GLS, global longitudinal strain.

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  Fig. 3. Clinical course of the patient. The solid and dotted lines show the trends in the LVEF and GLS, respectively. GLS declined before the decline in the LVEF 10 months before admission. In addition, the trend of each left ventricular diastolic function index is shown below the graph. Four months before admission, we could not measure them due to AVB. A, late transmitral flow velocity; AVB, atrioventricular block; Ave, averaged; CAG, coronary angiography; CRT, cardiac resynchronization therapy; E, early transmitral flow velocity; e′, early diastolic mitral annular velocity; GLS, global longitudinal strain; LVEF, left ventricular ejection fraction; NA, not available; TRV, tricuspid regurgitant velocity.