Assessment of left ventricular diastolic dysfunction by tissue Doppler imaging in patients with sclerodermia.

Background. Myocardial involvement in sclerodermia is related to patchy myocardial fibrosis attributed to intermittent and intense ischemia produced by microvascular occlusion. Although cardiac dysfunction can lead to heart failure or sudden cardiac death (particularly in patients with skeletal myopathy), it may also remain clinically silent despite extensive involvement. The purpose of our study was the evaluation of patients with sclerodermia by conventional Doppler echocardiography and tissue Doppler imaging (TDI) in order to detect early patterns of myocardial dysfunction. Methods. Twenty-six patients (age 54 +/- 13 years) with sclerodermia were studied. Exclusion criteria were non sinusal rhythm, hypertensive, ischemic, or valvular heart disease. Left ventricular ejection fraction (LVEF), fractional shortening (LVFS), and mitral flow filling parameters (E/A ratio, DT) were determined. Offline analysis of the myocardial velocity data sets was performed using dedicated software (Aplio, Toshiba Corp.). Velocity traces from the left ventricular free wall at 3 levels (basal, mid cavity, and apical) were processed in different cineloops in the apical views. Systolic (Sw) and diastolic (Ew, Aw) wall velocities were determined. Normal patterns (type 1) and relaxation or restrictive abnormalities (type 2 and 3) were examined for both standard and TDI indices. Results. All patients were asymptomatic and had normal LV dimensions, fractional shortening and segmental wall motion. 12 patients (group I) had septal hypertrophy and/or abnormal mitral inflow pattern (type 2 or 3). 14 patients (group II) had none of these abnormalities. 425 segments were analysed by TDI and a type 2 or 3 pattern was found in 139 (33%), from 20 patients. Five patients had pulmonary artery pressure >35mmHg. In six patients there was heterogeneous pattern in different segments and in thirteen a type 1 pattern was found in all segments, which was concordant with mitral flow Doppler pattern. Group I patients had an abnormal TDI pattern in all but one (95%). Nine Group II patients (64%) showed an abnormal TDI pattern. A significant difference was found between Ew and Sw in Groups I and II (p = 0.003 and 0.005, respectively). Conclusion. Thus in patients with sclerodermia and no cardiac involvement as assessed by conventional echocardiography, TDI showed abnormalities of longitudinal systolic and diastolic left ventricular function