Non-invasive assessment of systolic left ventricular function in systemic sclerosis

Systemic sclerosis is a multisystemic disorder, also affecting the heart. To evaluate its influence on systolic left ventricular (LV) function, we investigated 30 consecutive patients (age 54.5 ± 2.4 years, 15 men and 15 women) and 48 controls matched for age and sex. All subjects were investigated by phonocardiography, pulse curve recordings, M-mode echocardiography, and by pulsed and continuous wave Doppler. Heart rate, blood pressure and peripheral resistance did not differ, but patients weighed less than controls (P < 0.01). Systolic time intervals indicated systolic impairment, with an increased pre-ejection period to LV ejection time (LVET) ratio (0.37 ± 0.02 vs 0.30 ± 0.01 P < 0.001), and also an increased isovolumic contraction time to LVET ratio (0.17 ± 0.02 vs 0.12 ± 0.01, P < 0.02). The latter difference remained when LVET was adjusted for heart rate. Echocardiographic E-point to septal separation was increased in patients (8.3 ± 1.3 vs 4.8 ± 0.3 mm, P=0.001), also after adjustment for LV dimension (P=0.0001), while septal fractional thickening was decreased (P < 0.01). End systolic wall stress (P=0.0002) and stress to volume ratio (P=0.03) were lower in systemic sclerosis. Peak LV emptying rate was also lower in the patient group when measured by echocardiography (P=0.03). There was no difference between groups regarding LV dimensions, fractional shortening or mean velocity of circumferential fibre shortening. While aortic Doppler peak emptying rate did not differ between groups, it occurred later in systole in the patient group (P < 0-01) as did peak velocity (P=0.0001). Cardiac output did not differ between the groups. In all, 18 of 30 patients (60%) had a systolic abnormality. However, only one patient had dilated cardiomyapathy, and two other patients had poor systolic function without LV dilatation. There was no relation between disease duration and systolic LV function. We conclude that, in a consecutive series of patients with systemic sclerosis, systolic LV function is frequently impaired. While time intervals, emptying rate, and wall fractional thickening are affected, cardiac output and LV cavity dimensions are usually not.