Skip to main content
PMC home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 1996 Jul;55(7):455–460. doi: 10.1136/ard.55.7.455

Diastolic abnormalities in systemic sclerosis: evidence for associated defective cardiac functional reserve.

G Valentini 1, D F Vitale 1, A Giunta 1, S Maione 1, G Gerundo 1, M Arnese 1, E Tirri 1, N Pelaggi 1, A Giacummo 1, G Tirri 1, M Condorelli 1
PMCID: PMC1010209  PMID: 8774164

Abstract

OBJECTIVE: To investigate the pattern of diastolic abnormalities in patients with systemic sclerosis (SSc) and the relationship between impaired ventricular filling and systolic function. METHODS: Twenty four patients with SSc underwent M-mode and two dimensional echocardiography using echo-Doppler and gated blood pool cardiac angiography, both at rest and after exercise. RESULTS: An impaired diastolic relaxation of the left ventricle was detected in 10 of the 24 patients with SSc. Left ventricular ejection fraction at rest in these 10 patients with impaired ventricular filling did not differ from that in the remaining 14 patients, but eight of the 10 failed to increase their ejection fraction during exercise, compared with two of the 14 with normal ventricular filling (p = 0.003). CONCLUSION: Impaired relaxation of the left ventricle is a recently described feature of scleroderma heart disease. Diastolic dysfunction in SSc could depend on myocardial fibrosis or myocardial ischaemia, or both. It was found to be associated with a defective cardiac functional reserve. However, its prognostic significance remains to be clarified.

Full text

PDF
455

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alexander E. L., Firestein G. S., Weiss J. L., Heuser R. R., Leitl G., Wagner H. N., Jr, Brinker J. A., Ciuffo A. A., Becker L. C. Reversible cold-induced abnormalities in myocardial perfusion and function in systemic sclerosis. Ann Intern Med. 1986 Nov;105(5):661–668. doi: 10.7326/0003-4819-105-5-661. [DOI] [PubMed] [Google Scholar]
  2. Blaustein A. S., Gaasch W. H. Myocardial relaxation. VI. Effects of beta-adrenergic tone and asynchrony on LV relaxation rate. Am J Physiol. 1983 Mar;244(3):H417–H422. doi: 10.1152/ajpheart.1983.244.3.H417. [DOI] [PubMed] [Google Scholar]
  3. Bonow R. O., Bacharach S. L., Green M. V., Kent K. M., Rosing D. R., Lipson L. C., Leon M. B., Epstein S. E. Impaired left ventricular diastolic filling in patients with coronary artery disease: assessment with radionuclide angiography. Circulation. 1981 Aug;64(2):315–323. doi: 10.1161/01.cir.64.2.315. [DOI] [PubMed] [Google Scholar]
  4. Brutsaert D. L., Rademakers F. E., Sys S. U. Triple control of relaxation: implications in cardiac disease. Circulation. 1984 Jan;69(1):190–196. doi: 10.1161/01.cir.69.1.190. [DOI] [PubMed] [Google Scholar]
  5. Brutsaert D. L., Sys S. U., Gillebert T. C. Diastolic failure: pathophysiology and therapeutic implications. J Am Coll Cardiol. 1993 Jul;22(1):318–325. doi: 10.1016/0735-1097(93)90850-z. [DOI] [PubMed] [Google Scholar]
  6. Bulkley B. H., Ridolfi R. L., Salyer W. R., Hutchins G. M. Myocardial lesions of progressive systemic sclerosis. A cause of cardiac dysfunction. Circulation. 1976 Mar;53(3):483–490. doi: 10.1161/01.cir.53.3.483. [DOI] [PubMed] [Google Scholar]
  7. Casas J. A., Subauste C. P., Alarcón G. S. A new promising treatment in systemic sclerosis: 5-fluorouracil. Ann Rheum Dis. 1987 Oct;46(10):763–767. doi: 10.1136/ard.46.10.763. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Channer K. S., Culling W., Wilde P., Jones J. V. Estimation of left ventricular end-diastolic pressure by pulsed Doppler ultrasound. Lancet. 1986 May 3;1(8488):1005–1007. doi: 10.1016/s0140-6736(86)91273-0. [DOI] [PubMed] [Google Scholar]
  9. D'Angelo W. A., Fries J. F., Masi A. T., Shulman L. E. Pathologic observations in systemic sclerosis (scleroderma). A study of fifty-eight autopsy cases and fifty-eight matched controls. Am J Med. 1969 Mar;46(3):428–440. doi: 10.1016/0002-9343(69)90044-8. [DOI] [PubMed] [Google Scholar]
  10. Ellis W. W., Baer A. N., Robertson R. M., Pincus T., Kronenberg M. W. Left ventricular dysfunction induced by cold exposure in patients with systemic sclerosis. Am J Med. 1986 Mar;80(3):385–392. doi: 10.1016/0002-9343(86)90711-4. [DOI] [PubMed] [Google Scholar]
  11. Follansbee W. P., Curtiss E. I., Medsger T. A., Jr, Steen V. D., Uretsky B. F., Owens G. R., Rodnan G. P. Physiologic abnormalities of cardiac function in progressive systemic sclerosis with diffuse scleroderma. N Engl J Med. 1984 Jan 19;310(3):142–148. doi: 10.1056/NEJM198401193100302. [DOI] [PubMed] [Google Scholar]
  12. Follansbee W. P., Miller T. R., Curtiss E. I., Orie J. E., Bernstein R. L., Kiernan J. M., Medsger T. A., Jr A controlled clinicopathologic study of myocardial fibrosis in systemic sclerosis (scleroderma). J Rheumatol. 1990 May;17(5):656–662. [PubMed] [Google Scholar]
  13. Gaasch W. H., Blaustein A. S., Bing O. H. Asynchronous (segmental early) relaxation of the left ventricle. J Am Coll Cardiol. 1985 Apr;5(4):891–897. doi: 10.1016/s0735-1097(85)80429-0. [DOI] [PubMed] [Google Scholar]
  14. Giordano M., Valentini G., Migliaresi S., Picillo U., Vatti M. Different antibody patterns and different prognoses in patients with scleroderma with various extent of skin sclerosis. J Rheumatol. 1986 Oct;13(5):911–916. [PubMed] [Google Scholar]
  15. Kahan A., Devaux J. Y., Amor B., Menkès C. J., Weber S., Nitenberg A., Venot A., Guérin F., Degeorges M., Roucayrol J. C. Nifedipine and thallium-201 myocardial perfusion in progressive systemic sclerosis. N Engl J Med. 1986 May 29;314(22):1397–1402. doi: 10.1056/NEJM198605293142201. [DOI] [PubMed] [Google Scholar]
  16. Kazzam E., Waldenström A., Landelius J., Hällgren R., Arvidsson A., Caidahl K. Non-invasive assessment of left ventricular diastolic function in patients with systemic sclerosis. J Intern Med. 1990 Aug;228(2):183–192. doi: 10.1111/j.1365-2796.1990.tb00214.x. [DOI] [PubMed] [Google Scholar]
  17. Labovitz A. J., Pearson A. C. Evaluation of left ventricular diastolic function: clinical relevance and recent Doppler echocardiographic insights. Am Heart J. 1987 Oct;114(4 Pt 1):836–851. doi: 10.1016/0002-8703(87)90795-2. [DOI] [PubMed] [Google Scholar]
  18. Lew W. Y., Rasmussen C. M. Influence of nonuniformity on rate of left ventricular pressure fall in the dog. Am J Physiol. 1989 Jan;256(1 Pt 2):H222–H232. doi: 10.1152/ajpheart.1989.256.1.H222. [DOI] [PubMed] [Google Scholar]
  19. Maione S., Valentini G., Giunta A., Migliaresi S., Itri F., Picillo U., Tirri G., Condorelli M. Evaluation of cardiac structures and function in systemic sclerosis by Doppler echocardiography. Cardiology. 1991;79(3):165–171. doi: 10.1159/000174876. [DOI] [PubMed] [Google Scholar]
  20. Pace L., Capelli L., Bove E., Coppola N., Ciarmiello A., Sorrentino S., Salvatore M. Left ventricular diastolic function in systemic sclerosis: assessment by radionuclide angiography. J Nucl Med. 1992 Jan;33(1):68–72. [PubMed] [Google Scholar]
  21. Polak J. F., Kemper A. J., Bianco J. A., Parisi A. F., Tow D. E. Resting early peak diastolic filling rate: a sensitive index of myocardial dysfunction in patients with coronary artery disease. J Nucl Med. 1982 Jun;23(6):471–478. [PubMed] [Google Scholar]
  22. Sahn D. J., DeMaria A., Kisslo J., Weyman A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation. 1978 Dec;58(6):1072–1083. doi: 10.1161/01.cir.58.6.1072. [DOI] [PubMed] [Google Scholar]
  23. Siegel R. J., O'Connor B., Mena I., Criley J. M. Left ventricular function at rest and during Raynaud's phenomenon in patients with scleroderma. Am Heart J. 1984 Dec;108(6):1469–1476. doi: 10.1016/0002-8703(84)90694-x. [DOI] [PubMed] [Google Scholar]
  24. Steen V. D., Medsger T. A., Jr, Rodnan G. P. D-Penicillamine therapy in progressive systemic sclerosis (scleroderma): a retrospective analysis. Ann Intern Med. 1982 Nov;97(5):652–659. doi: 10.7326/0003-4819-97-5-652. [DOI] [PubMed] [Google Scholar]
  25. Takeuchi M., Fujitani K., Kurogane K., Bai H. T., Toda C., Yamasaki T., Fukuzaki H. Effects of left ventricular asynchrony on time constant and extrapolated pressure of left ventricular pressure decay in coronary artery disease. J Am Coll Cardiol. 1985 Sep;6(3):597–602. doi: 10.1016/s0735-1097(85)80118-2. [DOI] [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES