Echocardiographic And Humoral Parametres In Systemic Sclerosis And Mctd In Relation To Pulmonary Hypertension

Background Echocardiography at our department is performed routinely in all patients with connective tissue diseases, where a suspicion or diagnosis of pulmonary hypertension is found by screening in lower percentage of patients only. Objectives The aim of our study is to evaluate the importance of deformation analysis of right vectricle free wall using 2D strain by speckle trackinkg and other parametres of systolic function of the right ventricle (fractional area change, FAC) from the point of view of their predictive potential for early phase pulmonary hypertension detection in patient with systemic sclerosis and related diseases. Methods From april 2013 to september 2014 we examined by echocardiography total 74 patients, 63 patients with systemic sclerosis and 11 patients with mixed connective tissue disesase. Except routine left and right ventricle assessment and pulmonary pressure estimation, the FAC of the right ventricle and 2D strain of right ventricle free wall were evaluated and further NT-proBNP, Troponin T were measured. In addition all patients had determined DLCO and selected patients underwent right heart catheterization. Measured parametres were correlated and their predictive potential was calculated. Results Pulmonary hypertension (PH) was found as unlikely in 59 patients (79,7%), possible in 10 patients (13,5%) and probable in 5 patient (6,7%). Statistical significant relation was found for PASP and RV free wall middle segment strain (rs =0,292, p=0,012), for PASP and NT-proBNP (rs =0,436 p=0,001) and further for PASP and FAC (rs 0,320, p 0,005). No correlation of pulmonary artery pressure with left ventricle sytolic function parametres was found in these patients. Conclusions Presence of pulmonary hypertension is important finding influencing prognosis in patient with systemic sclerosis and related diseases and active search for PH is necessary to select patient indicated to invasive investigation an possible specific treatment. References Lefevre G, Dauchet L, Hachulla E et al. Survival and prognostic factors in systemic sclerosis -associated pulmonary hypertension: a systematic review and meta-analysis. Arthritis Rheum. 2013 Sep; 65(9):2412-23. Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23(7):685-713. Spethmann S, Dreger H, Schattke S et al. Two-dimensional speckle tracking of the left ventricle in patients with systemic sclerosis for an early detection of myocardial involvement. Eur Heart J Cardiovasc Imaging. 2012 Oct;13(10):863-870. Disclosure of Interest None declared