Heart involvement in systemic sclerosis.

INTRODUCTION: Primary and secondary heart involvement in systemic sclerosis are important mortality predictors. Aim of this study was to investigate by standard echocardiography associated to pulsed-tissue Doppler imaging, six-minute walk test (6MWT) and BNP level cardiac manifestation in 30 patients with ScS and to establish a strategy to detect and to evaluate this complication. METHODS: This was a cross-sectional study conducted over a period of 16 months: a total of 30 consecutive patients with ScS diagnosed as proposed by the American college of Rheumatology and the European League Against Rheumatism 2013 and who were hospitalized in Internal Medicine department of Habib Thameur hospital underwent cardiac assessment. RESULTS: Twenty-nine patients were female, the mean age of diagnosis was 46 years ± 13,49  [18-71 years]. Echocardiography found left ventricular systolic dysfunction (LVSD) on tissue doppler imaging, in 40% of cases, it was significantly associated with diffuse ScS (p=0,024), with Scl70 anti bodies (p=0,043) and interstitial lung disease (p=0,024). However, the left ventricular diastolic dysfunction (LVDD) was correlated with a high diastolic arterial hypertension (p=0,028), diffuse ScS (0,048), telangiectasia (p=0,029) and pulmonary hypertension (p=0,033). Higher systolic pulmonary arterial pressure (PAPs) (p=0,029) and higher BNP level (p=0,027) were noted in the group of patients with right ventricular systolic dysfunction (RVSD). Patients who had an elevated PAPs had: accelerated pulse (p=0,022), a cough (p=0,024), dyspnea III-IV (p=0,003), shorter six-minute walk distance (p=0,044), greater Borg score (p=0,025) and elevated BNP level (p=0,015). Thus, a positive correlation was found between PAPs and BNP (p=0,004, r=+0,53), a negative correlation was noted between PAPs and ST (p=0,006, r=-0,49). The ROC curve identified a discriminator threshold for ST<11,5cm/s (BNP ≥43,5pg/l) and PAPs >35mmHg (BNP ≥92pg/l). A discriminator value of the 6MWD (≥294m) was recorded for a PAPs >35mmHg. 2000-3000 salma Conclusion: Left ventricular diastolic impairment was the most frequent echographic abnormality in our study. The BNP level and 6MWT are sensitive and specific in the detection of an elevation of PAPs.

Right ventricular systolic echocardiographic parameters in dilated cardiomyopathy and prognosis.

BACKGROUND: Right ventricular (RV) dysfunction is associated with poor prognosis in patients with non-ischemic dilated cardiomyopathy. Several RV echocardiographic parameters have been proposed as sensitive markers to detect patients at risk. OBJECTIVE: To compare the predictive value of echographic parameters of RV systolic function for adverse outcomes in patients with non-ischemic dilated cardiomyopathy. METHODS:    Forty patients with non-ischemic dilated cardiomyopathy were included. Right ventricular systolic function assessed by Doppler echocardiography standard (RV fractional area change, Tei index, TAPSE and dp/dt), tissue Doppler (peak systolic velocity (Sa)) and Strain 2D of the RV. The primary endpoint was the occurrence of a major cardiovascular event. The follow-up extended for 6.2 months ± 2,49. RESULTS: Eighteen patients reached the primary endpoint. TAPSE (HR 0.86 [0.74-0.99], p=0.04), Sa (HR 0.77 [0.62-0.95], p=0.01), Tei index (HR 1.06 [1.01-1.12], p=0.02) and strain of the lateral wall of the RV (HR 1.13 [1.04-1.23], p=0.004) were found to be independent predictors of major cardiovascular event. The cut-off thresholds for TAPSE, Sa, Tei index and strain of the lateral wall of th RV, defined using ROC curves were respectively 12,5mm ; 8,5cm/s ; 0,55 et -12. CONCLUSION: TAPSE, Sa, Tei index and strain of the lateral wall of the RV are independent predictors of major cardiovascular event in non ischemic dilated cardiomyopathy.

Differences between idiopathic and ischemic dilated cardiomyopathy.

BACKGROUND: Ischemic cardiomyopathy can be reversible after revascularization hence the interest of making systematic coronary angiography that remain an invasive procedure. AIM: To detect epidemiological, clinical and paraclinical differences between idiopathic and ischemic dilated cardiomyopathy to identify predictors of coronary artery disease and to evaluate the interest of making systematic coronary angiography within the etiological check-up of dilated cardiomyopathy. METHODS: We performed a retrospective study in patients with dilated cardiomyopathy in whom coronary angiography allowed to distinguish the ischemic cardiomyopathy group from that of idiopathic cardiomyopathy. We compared the clinical and paraclinical findings between these two groups. RESULTS: We identified 102 patients: 42 had ischemic cardiomyopathy and 60 had idiopathic cardiomyopathy. These two groups were comparable according to age and sex. Diabetes was significantly more common (p = 0.002) in the first group. Dyspnea was more common in the second group (p = 0.03) as well as atrial fibrillation and left bundle branch block (p=0,04 and p=0,05, respectively). Renal failure, fasting hyperglycemia and echocardiographic segmental wall motion abnormalities were significantly more frequent in the group of ischemic cardiomyopathy (p=0.01). In multivariate analysis, diabetes (OR=3,291, IC95% : 1,167-10,969), renal failure (OR=11,001, IC95% : 2,15-39,85) and segmental wall motion abnormalities (OR=2,351, IC95% :0.934-5.915) were independent predictors of ischemic dilated cardiomyopathy. CONCLUSION: Diabetes, kidney failure and disorders of wall motion appears to be predictors for the ischemic origin of dilated cardiomyopathy and thereby help to limit the routine use of this invasive technique in the diagnosis.