Results
Clinical Characteristics
Table 1 showed the clinical biological characteristics of SSc patients as well as the results of right heart catheterization. Importantly, all patients had normal mean PAP values.
Conventional Echocardiographic Data
Conventional echocardiographic findings are presented in Table 2. There were no differences between baseline and follow-up examination regarding heart rate, left ventricular volumes, aortic valve peak velocity and diastolic function. (Table 2).
Speckle Tracking Strain Data, DTI Systolic Velocities and Systolic Left Ventricular Function
Table 3 shows global speckle tracking strain data and systolic left ventricular function. LVEF at baseline was normal in all patients and remained stable at follow-up examination (63.3 ± 4.2% vs. 63.2 ± 5.0%, p = ns) (Figure 1). In addition, the mean peak systolic velocities were also unchanged (7.9 ± 1.7 vs. 7.9 ± 1.9, p = ns).
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Figure 1.
Global longitudinal peak systolic strain (PSS) (A) and left ventricular ejection fraction (B) in systemic sclerosis (SSc) patients at baseline and at follow up.
The mean global PSS value at follow-up was still in normal range, but significantly reduced compared to baseline examination (baseline -22.0 ± 2.3% vs. follow-up -20.8 ± 3.5%, p = 0.04) (Table 3 and Figure 1). Figure 2 shows the intraindividual course of the PSS. This was mainly influenced by lower strain in the four-chamber view (-22.1 ± 2.5% vs. -19.8 ± 3.5%, p = 0.006) while there was only a trend for lower strain in the two-chamber view and apical long axis view.
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Figure 2.
Intraindividual course of the global longitudinal peak systolic strain at baseline (Left Panel) and at follow-up (Right Panel).
Regarding regional analysis we found reduced mean PSS in all segments but only the medial segments in the four-chamber view were statistically significant (Table 4 and Figure 3).
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Figure 3.
Colour-coding of the average regional longitudinal peak systolic strain in patients with SSC at baseline (Left Panel) and at follow-up (Right Panel). A: The apical long axis view. B: The four chamber view. C: The two chamber view.
Inter- and Intraobserver Variability
The intraobserver variability for the LV longitudinal strain was 0.93 (CI 0.79–0.98). The interobserver variability for the LV longitudinal strain was 0.90 (CI 0.57–0.99).