Mitral regurgitation and diastolic flow profile in systemic sclerosis

To evaluate the left ventricular filling characteristics in systemic sclerosis, we examined 30 consecutive patients, 15 men and 15 women, and related the findings to those from 48 age- and sex-matched controls. All patients were investigated by pulsed and continuous wave mitral Doppler, and M mode echocardiography. We found the A wave of the mitral flow velocity as recorded by pulsed wave Doppler to be higher in patients (0.74 ± 0.07 vs 0.54 ± 0.02 m/sec, P < 0.002), while the E wave did not differ. The high A E ratio indicating reduced distensibility, correlated to interventricular septal thickness (r = 0.53, P < 0.001), and atrial emptying index (r = -0.55, P < 0.001). Early filling was impaired, with a prolonged pressure half time (99 ± 6 vs 84 ± 4 msec, P < 0.05), and a reduced first third filling fraction (0.41 ± 0.02 vs 0.48 ± 0.01, P < 0.001). Mitral regurgitation was found in 67% of systemic sclerosis patients and in 15% of controls (P < 0.001). Doppler measures of left ventricular filling properties were not related to the presence of mitral regurgitation or systolic blood pressure. We conclude that left ventricular distensibility and early filling properties are impaired in systemic sclerosis and not related to blood pressure, but rather to left ventricular wall thickness and therefore probably secondary to myocardial fibrosis. Mitral regurgitation is a common finding in systemic sclerosis.