Echocardiogram in scleroderma

Background. Scleroderma is an infrequent and chronic collagen vascular disease characterized by the vascular engagement of the small arteries and tisular fibrosis. Cardiac manifestations, though common, are present in only one third of the patients and there are associated to a deleterious outcome. The aim of this study was to describe the echocardiographic features present in patients with scleroderma and compare them with a control group.
Methods. Fifty four patients with scleroderma (57 ± 13 years; 93% female sex) and 11 normal patients (48 ± 20 years; 80% female sex) were included. Echocardiographic studies were achieved following the American Society of Echocardiography guidelines.
Results. Patients with scleroderma had larger right ventricles: 20.6 ± 4.5 mm vs 15.4 ± 4.3 mm; p=0.02. Doppler analysis showed a greater systolic pulmonary pressure (27.3 ± 5.5 mm Hg vs 20.3 ± 3 mm Hg; p=0.0001) and a shorter right ventricle ejective time (270 ± 57 ms vs 333 ± 32 ms; p=0.001) in the scleroderma group. Tisular Doppler revealed a greater left ventricular A’ wave (15.3 ± 3.6 cm/sec vs 1.7 ± 2.6 cm/sec; p=0.01), a taller right ventricle A’wave (17.6 ± 3.6 cm/sec vs 13.6 ± 3.4 cm/sec; p=0.001) and a smaller E’/A’ ratio (0.9 ± 0.39 vs 1.13 ± 0.18; p=0.01) in patients with scleroderma.
Conclusions. Patients with scleroderma had a larger right ventricle and higher pulmonary pressure. The tisular Doppler findings suggest a lesser ventricular distensibility. It may be a consequence of the greater pulmonary pressure and the intrinsic myocardial damage.

Keywords: Scleroderma; Doppler echocardiography; Diastolic function; Pulmonary hypertension