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Decreased biventricular longitudinal strain in patients with systemic sclerosis is mainly caused by pulmonary hypertension and not by systemic sclerosis per se
Author(s) -
Lindholm Anthony,
Hesselstrand Roger,
Rådegran Göran,
Arheden Håkan,
Ostenfeld Ellen
Publication year - 2019
Publication title -
clinical physiology and functional imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.608
H-Index - 67
eISSN - 1475-097X
pISSN - 1475-0961
DOI - 10.1111/cpf.12561
Subject(s) - medicine , cardiology , pulmonary hypertension , vascular resistance , magnetic resonance imaging , pulmonary artery , blood pressure , radiology
Summary Purpose Patients with pulmonary arterial hypertension ( PAH ) due to systemic sclerosis ( SS c) have high mortality. Left ventricular ( LV ) peak global longitudinal strain ( GLS ) is decreased in SS c. It is unknown whether low GLS is due to SS c or PAH . Therefore, our primary aim was to evaluate both LV and right ventricular free wall GLS (RVFW GLS ) in SS c, with and without PAH , using cardiac magnetic resonance with feature tracking. Secondary aim was to relate GLS to invasive mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance ( PVR ). Methods Thirty‐eight patients with SS c, 19 patients with SS c‐ PAH and 19 healthy controls for comparison, were included. Endocardial and epicardial borders were delineated in cine images (short‐axis stack and three long‐axis views) for volumetric and strain calculations. Results Systemic sclerosis‐ PAH had lower LV and RVFW GLS than SS c ( LV : P = 0·01, RV : P <0·001) and controls ( LV : P = 0·02; RV : P <0·001), with no difference between SS c and controls. LV strain correlated with mPAP ( R = 0·42, P = 0·03) and PVR ( R = 0·52, P = 0·006). RVFW GLS correlated with mPAP ( R = 0·68, P <0·001) and PVR ( R = 0·59, P = 0·001). ROC curves for predicting PAH had AUC 0·73 for LV strain ( P = 0·003) and 0·86 for RVFW GLS ( P <0·001). Conclusions Lower GLS is mainly determined by increased pulmonary pressure and not by SS c per se . Low LV and RVFW GLS are indicative of increased mPAP and PVR , which opens for improved non‐invasive methods to select patients eligible for right heart catheterization and to monitor the effects of PAH therapy.