Right ventricular diastolic abnormalities in systemic sclerosis. Relation to left ventricular involvement and pulmonary hypertension

Objectives-To investigate right ventricular diastolic function in systemic sclerosis (SSc) and its relation to clinical features of the disease. Methods-Seventy seven unselected SSc patients and 33 healthy subjects were submitted to echocardiography and echo Doppler study to assess left and rig ht systolic as well diastolic function and to estimate maximal arterial sys tolic pulmonary pressure (PAP). In addition, the patients were investigated to define the SSc subset and the extent of skin and internal organ involve ment. Results-An abnormal right ventricular filling, as expressed by an inverted tricuspidal (Tr) E/A ratio (Tr E/A ratio <1), was detected in 31 of the 77 SSc patients (40%) and in 0 of the 36 controls (p < 0.001). All the 31 pati ents with an inverted Tr EIA ratio were found to have a PAP > 30 mm Hg, Twe nty resulted to have an inverted mitral (Mit) E/A ratio (Mit E/A ratio <1), indicating an abnormal left ventricular filling. In multiple regression an alysis, Tr E/A ratio resulted to be independently correlated to both PAP (r = -0.35; p < 0.003) and Mit E/A ratio (r = 0.39; p < 0.001). Conclusions-This study points out an impaired right ventricular filling in a significant percentage of SSc patients whatever the subset. This alterati on is independently correlated to both PAP and left ventricular filling abn ormalities.