Deformation analysis of the right ventricle using speckle tracking in the diagnosis of pulmonary arterial hypertension in patients with systemic sclerosis and mixed connective tissue disease

Czech version

Authors: J. Vymětal ¹; M. Hutyra ²; A. Smržová ¹; M. Skácelová ¹; Z. Heřmanová ³; K. Langová ⁴; P. Horák ¹
Authors‘ workplace: 3. interní klinika – nefrologická, revmatologická a endokrinologická, LF UP a FN Olomouc ¹; 1. interní klinika – kardiologická, LF UP a FN Olomouc ²; Oddělení imunologie, LF UP a FN Olomouc ³; Oddělení biostatistiky, LF UP Olomouc ⁴
Published in: Čes. Revmatol., 23, 2015, No. 4, p. 123-132.
Category: Original Papers

Overview

Pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) is serious and life prognosis influencing organ complication. Its early non-invasive detection is based on regular screening echocardiography. The aim of this study is to assess the contribution of right ventricle longitudinal strain (RVLS) performed by speckle tracking echocardiography in PAH diagnostics.

Cohort and Methods:
Total 74 patients (60 patients with systemic sclerosis and 14 patients with mixed connective tissue disease) was examined by echocardiography; Besides routine left and right ventricle (RV) function assessment and pulmonary pressure estimation, the fractional area change (RV-FAC) of the right ventricle and 2D strain of right ventricle free wall were evaluated. Concurrently, levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), Troponin T, characteristic auto antibodies and diffuse lung capacity for carbon monoxide (DLCO) were measured. Patients with probable pulmonary hypertension underwent right heart catheterization (RHC).

Results:
Pulmonary hypertension (PH) was unlikely in 59 patients (79.7 %), possible in 10 patients (13.5 %) and probable in 5 patient (6.7 %). A significant correlation was found for pulmonary artery systolic pressure (PASP) and RV free wall global longitudinal, resp. middle segment strain (r = 0.292, p = 0.012), for PASP and NT-proBNP (r = 0,436 p = 0.001) and further for PASP and RV-FAC (r = 0.320, p 0.005). The pulmonary artery systolic pressure did not correlate with left ventricle systolic or diastolic functions parameters in this cohort.

Conclusion:
Right ventricle strain measurement can be an useful complement in patients with systemic sclerosis and pulmonary hypertension.

Key words:
scleroderma, mixed connective tissue disease, echocardiography, speckle tracking

Sources

1. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010; 23(7): 685–713.

2. Khanna D, Gladue H, Channick R, Chung L, Distler O, Furst DE, et al. Recommendations for screening and detection of connective tissue disease-associated pulmonary arterial hypertension. Arthritis Rheum 2013; 65(12): 3194–201.

3. Spethmann S, Rieper K, Riemekasten G, Borges AC, Schattke S, Burmester GR, et al. Echocardiographic follow-up of patients with systemic sclerosis by 2D speckle tracking echocardiography of the left ventricle. Cardiovasc Ultrasound 2014; 12: 13.

4. Durmus E, Sunbul M, Tigen K, Kivrak T, Ozen G, Sari I, et al. Right ventricular and atrial functions in systemic sclerosis patients without pulmonary hypertension: Speckle-tracking echocardiographic study. Herz 2014; 40(4): 709–15.

5. Mondillo S, Galderisi M, Mele D, Cameli M, Lomoriello VS, Zaca V, et al. Speckle-tracking echocardiography: a new technique for assessing myocardial function. J Ultrasound Med 2011; 30(1): 71–83.

6. Bečvář R, Soukup T, Štork J, Suchý D, Němec P, Jansa P, et al. Doporučení České revmatologické společnosti pro diagnostiku systémové sklerodermie. Čes Revmatol 2014; 22(2): 51–68.

7. van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, et al. 2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative. Ann Rheum Dis 2013; 72(11): 1747–55.

8. Galie N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J 2009; 30(20): 2493–537.

9. Hachulla E, Clerson P, Airò P, Cuomo G, Allanore Y, Caramaschi P, et al. Value of systolic pulmonary arterial pressure as a prognostic factor of death in the systemic sclerosis EUSTAR population. Rheumatology (Oxford) 2015; 54(7): 1262–9.

10. Chung L, Farber HW, Benza R, Miller DP, Parsons L, Hassoun PM, et al. Unique Predictors of Mortality in Patients With Pulmonary Arterial Hypertension Associated With Systemic Sclerosis in the Reveal Registry. Chest 2014; 146(6): 1494-504.

11. Chung L, Domsic RT, Lingala B, Alkassab F, Bolster M, Csuka ME, et al. Survival and predictors of mortality in systemic sclerosis-associated pulmonary arterial hypertension: outcomes from the pulmonary hypertension assessment and recognition of outcomes in scleroderma registry. Arthritis Care Res 2014; 66(3): 489–95.

12. Mukerjee D, St George D, Coleiro B, Knight C, Denton CP, Davar J, et al. Prevalence and outcome in systemic sclerosis associated pulmonary arterial hypertension: application of a registry approach. Ann Rheum Dis 2003; 62(11): 1088–93.

13. Avouac J, Airo P, Meune C, Beretta L, Dieude P, Caramaschi P, et al. Prevalence of pulmonary hypertension in systemic sclerosis in European Caucasians and metaanalysis of 5 studies. J Rheumatol 2010; 37(11): 2290–8.

14. Iudici M, Codullo V, Giuggioli D, Riccieri V, Cuomo G, Breda S, et al. Pulmonary hypertension in systemic sclerosis: prevalence, incidence and predictive factors in a large multicentric Italian cohort. Clin Exp Rheumatol 2013; 31(Suppl 76): 31-6.

15. Jansa P, Becvar R, Ambroz D, Palecek T, Tomcik M, Skacelova S, et al. Pulmonary arterial hypertension associated with systemic sclerosis in the Czech Republic. Clin Rheumatol 2012; 31(3): 557–61.

16. Codullo V, Caporali R, Cuomo G, Ghio S, D'Alto M, Fusetti C, et al. Stress Doppler echocardiography in systemic sclerosis: evidence for a role in the prediction of pulmonary hypertension. Arthritis Rheum 2013; 65(9): 2403–11.

17. Tolle JJ, Waxman AB, Van Horn TL, Pappagianopoulos PP, Systrom DM. Exercise-induced pulmonary arterial hypertension. Circulation 2008; 118(21): 2183–9.

18. Saggar R, Khanna D, Furst DE, Shapiro S, Maranian P, Belperio JA, et al. Exercise-induced pulmonary hypertension associated with systemic sclerosis: four distinct entities. Arthritis Rheum 2010; 62(12): 3741–50.

19. Hager WD, Collins I, Tate JP, Azrin M, Foley R, Lakshminarayanan S, et al. Exercise during cardiac catheterization distinguishes between pulmonary and left ventricular causes of dyspnea in systemic sclerosis patients. Clin Respir J 2013; 7(3): 227–36.

20. Coghlan JG, Denton CP, Grünig E, Bonderman D, Distler O, Khanna D, et al. Evidence-based detection of pulmonary arterial hypertension in systemic sclerosis: the DETECT study. Ann Rheum Dis 2014; 73(7): 1340–9.

21. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010; 23(7): 685–713.

22. Khanna D, Gladue H, Channick R, Chung L, Distler O, Furst DE, et al. Recommendations for screening and detection of connective tissue disease-associated pulmonary arterial hypertension. Arthritis Rheum 2013; 65(12): 3194–201.

23. Spethmann S, Rieper K, Riemekasten G, Borges AC, Schattke S, Burmester GR, et al. Echocardiographic follow-up of patients with systemic sclerosis by 2D speckle tracking echocardiography of the left ventricle. Cardiovasc Ultrasound 2014; 12: 13.

24. Durmus E, Sunbul M, Tigen K, Kivrak T, Ozen G, Sari I, et al. Right ventricular and atrial functions in systemic sclerosis patients without pulmonary hypertension: Speckle-tracking echocardiographic study. Herz 2014; 40(4): 709–15.

25. Mondillo S, Galderisi M, Mele D, Cameli M, Lomoriello VS, Zaca V, et al. Speckle-tracking echocardiography: a new technique for assessing myocardial function. J Ultrasound Med 2011; 30(1): 71-83.

26. Bečvář R, Soukup T, Štork J, Suchý D, Němec P, Jansa P, et al. Doporučení České revmatologické společnosti pro diagnostiku systémové sklerodermie. Čes Revmatol 2014; 22(2): 51–68.

27. van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, et al. 2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative. Ann Rheum Dis 2013; 72(11): 1747–55.

28. Galie N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J 2009; 30(20): 2493–537.

29. Hachulla E, Clerson P, Airò P, Cuomo G, Allanore Y, Caramaschi P, et al. Value of systolic pulmonary arterial pressure as a prognostic factor of death in the systemic sclerosis EUSTAR population. Rheumatology (Oxford) 2015; 54(7): 1262–9.

30. Chung L, Farber HW, Benza R, Miller DP, Parsons L, Hassoun PM, et al. Unique Predictors of Mortality in Patients With Pulmonary Arterial Hypertension Associated With Systemic Sclerosis in the Reveal Registry. Chest 2014; 146(6): 1494–504.

31. Chung L, Domsic RT, Lingala B, Alkassab F, Bolster M, Csuka ME, et al. Survival and predictors of mortality in systemic sclerosis-associated pulmonary arterial hypertension: outcomes from the pulmonary hypertension assessment and recognition of outcomes in scleroderma registry. Arthritis Care Res 2014; 66(3): 489–95.

32. Mukerjee D, St George D, Coleiro B, Knight C, Denton CP, Davar J, et al. Prevalence and outcome in systemic sclerosis associated pulmonary arterial hypertension: application of a registry approach. Ann Rheum Dis 2003; 62(11): 1088–93.

33. Avouac J, Airo P, Meune C, Beretta L, Dieude P, Caramaschi P, et al. Prevalence of pulmonary hypertension in systemic sclerosis in European Caucasians and metaanalysis of 5 studies. J Rheumatol 2010; 37(11): 2290–8.

34. Iudici M, Codullo V, Giuggioli D, Riccieri V, Cuomo G, Breda S, et al. Pulmonary hypertension in systemic sclerosis: prevalence, incidence and predictive factors in a large multicentric Italian cohort. Clin Exp Rheumatol 2013; 31(Suppl 76): 31–6.

35. Jansa P, Becvar R, Ambroz D, Palecek T, Tomcik M, Skacelova S, et al. Pulmonary arterial hypertension associated with systemic sclerosis in the Czech Republic. Clin Rheumatol 2012; 31(3): 557–61.

36. Codullo V, Caporali R, Cuomo G, Ghio S, D'Alto M, Fusetti C, et al. Stress Doppler echocardiography in systemic sclerosis: evidence for a role in the prediction of pulmonary hypertension. Arthritis Rheum 2013; 65(9): 2403–11.

37. Tolle JJ, Waxman AB, Van Horn TL, Pappagianopoulos PP, Systrom DM. Exercise-induced pulmonary arterial hypertension. Circulation 2008; 118(21): 2183–9.

38. Saggar R, Khanna D, Furst DE, Shapiro S, Maranian P, Belperio JA, et al. Exercise-induced pulmonary hypertension associated with systemic sclerosis: four distinct entities. Arthritis Rheum 2010; 62(12): 3741–50.

39. Hager WD, Collins I, Tate JP, Azrin M, Foley R, Lakshminarayanan S, et al. Exercise during cardiac catheterization distinguishes between pulmonary and left ventricular causes of dyspnea in systemic sclerosis patients. Clin Respir J 2013; 7(3): 227–36.

40. Coghlan JG, Denton CP, Grünig E, Bonderman D, Distler O, Khanna D, et al. Evidence-based detection of pulmonary arterial hypertension in systemic sclerosis: the DETECT study. Ann Rheum Dis 2014; 73(7): 1340–9.

41. Galiè N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J [First published online] 2015 Aug 29. Available from http://dx.doi.org/10.1093/eurheartj/ehv317.

42. Freed BH, Tsang W, Bhave NM, Patel AR, Weinert L, Yamat M, et al. Right Ventricular Strain in Pulmonary Arterial Hypertension: A 2D Echocardiography and Cardiac Magnetic Resonance Study. Echocardiography 2015; 32(2): 257–63.

43. Ikeda S, Tsuneto A, Kojima S, Koga S, Nakata T, Yoshida T, et al. Longitudinal strain of right ventricular free wall by 2-dimensional speckle-tracking echocardiography is useful for detecting pulmonary hypertension. Life Sci 2014; 111(1-2): 12–7.

44. Focardi M, Cameli M, Carbone SF, Massoni A, De Vito R, Lisi M, et al. Traditional and innovative echocardiographic parameters for the analysis of right ventricular performance in comparison with cardiac magnetic resonance. Eur Heart J Cardiovasc Imaging 2015; 16(1): 47–52.

45. Gladue H, Altorok N, Townsend W, McLaughlin V, Khanna D. Screening and diagnostic modalities for connective tissue disease-associated pulmonary arterial hypertension: a systematic review. Semin Arthritis Rheum 2014; 43(4): 536–41.

46. Grader-Beck T, Boin F, von Gunten S, Smith D, Rosen A, Bochner BS. Antibodies recognising sulfated carbohydrates are prevalent in systemic sclerosis and associated with pulmonary vascular disease. Ann Rheum Dis 2011; 70(12): 2218–24.

47. Allanore Y, Borderie D, Avouac J, Zerkak D, Meune C, Hachulla E, et al. High N-terminal pro-brain natriuretic peptide levels and low diffusing capacity for carbon monoxide as independent predictors of the occurrence of precapillary pulmonary arterial hypertension in patients with systemic sclerosis. Arthritis Rheum 2008; 58(1): 284–91.

48. Thakkar V, Stevens W, Prior D, Youssef P, Liew D, Gabbay E, et al. The inclusion of N-terminal pro-brain natriuretic peptide in a sensitive screening strategy for systemic sclerosis-related pulmonary arterial hypertension: a cohort study. Arthritis Res Ther 2013; 15(6): R193.

49. Nihtyanova SI, Tang EC, Coghlan JG, Wells AU, Black CM, Denton CP. Improved survival in systemic sclerosis is associated with better ascertainment of internal organ disease: a retrospective cohort study. QJM 2010; 103(2): 109–15.

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2015 Issue 4