The impact of systemic sclerosis on the structure and function of the heart and periferal microcirculation

[M. B. Zlatanović]

90 listova

Medicina - Interna medicina - reumatologija / Medicine - Internal medicine – rheumatology

Sistemska skleroza je kompleksno autoimuno oboljenje koje karakteriše sistemska fibroza i vaskularno oštećenje. Kardiološke i pulmološke manifestacije bolesti su glavni uzroci morbiditeta i mortaliteta. Fibroza dovodi do strukturnog, funkcionalnog i mehaniĉkog remodelovanja leve i desne komore, što dalje moţe izazvati poremećaje sprovoĊenja i aritmije. Nove ehokardiografske tehnike pruţaju uvid u srĉanu funkciju i mehaniku uporedivu sa onim kod magnetne rezonance srca, "zlatnog standarda" meĊu metodama vizuelizacije srca. Varijabilnost srĉane frekvencije je vrlo pouzdana neinvazivna tehnika koja ispituje autonomni nervni sistem, simpatiĉku i parasimpatiĉku aktivnost, dobijenu iz 24-ĉasovnog EKG zapisa. MeĊutim, još uvek je nedovoljno ispitan odnos izmeĊu parametara mehanike srca i neravnoteţe autonomne funkcije kod bolesnika sa sistemskom sklerozom, a koji moţe imati znaĉajne kliniĉke implikacije u predviĊanju nepovoljnog ishoda kod ovih bolesnika. Cilj: Ovo istraţivanje je imalo za cilj da ispita strukturu, funkciju i mehaniku srca, i proceni autonomnu funkciju kod bolesnika sa sistemskom sklerozom. TakoĊe, imalo je za cilj da ispita meĊusobni odnos izmeĊu novih ehokardiografski parametara i parametara autonomne funkcije srca, kao i njihov odnos sa pokazateljima periferne mikroangiopatije kod ovih bolesnika. Metodologija: Istraţivanje je obuhvatilo 45 bolesnika sa sistemskom sklerozom, bez kardiovaskularnih simptoma, koji se leĉe u Institutu za reumatologiju u Beogradu i 30 zdravih dobrovoljaca uparenih prema uzrastu i polu. Kod svih bolesnika ukljuĉenih u istraţivanje obavljen je kliniĉki pregled, modifikovani Rodnanov skin skor, serološki testovi, testovi plućne funkcije, kapilaroskopija, indeks aktivnosti bolesti, 24-ĉasovni Holter EKG putem koga je analizirana varijabilnost srĉane frekvencije u vremenskom i frekventnom domenu, i kompletna dvodimenzionalna ehokardiografija, ukljuĉujući analizu straina putem speckle tracking metode. Rezultati: Parametri strukture leve komore (debljina meĊukomorskog septuma, relativna debljina zida leve komore, indeks mase leve komore, indeks volumena leve pretkomore, p<0.01) i desne ventrikularne strukture (debljina zida desne komore, p<0.01) znaĉajno su bili veći kod bolesnika sa sistemskom sklerozom...

Systemic sclerosis (SSc) is an autoimmune complex disease characterized by systemic fibrosis and vascular lesions. Cardiac and pulmonary disease manifestations are major causes of morbidity and mortality. Fibrosis leads to both left ventricular and right ventricular structural, functional and mechanical remodeling, which further could induce conduction disturbances and arrhythmias. New imaging echocardiography techniques offered an insight into cardiac function and mechanics comparable with that of cardiac magnetic resonance, the ―gold standard‖ cardiac imaging modality. Heart rate variability is a very good non-invasive technique that investigates the autonomic nervous system, both sympathetic and parasympathetic activity, derived from ECG recordings. The investigations about the association between cardiac mechanics and autonomic imbalance in systemic sclerosis patients, which might have a significant clinical implication and prediction of unfavorable outcomes, is still lacking. Aim: We aimed to determine left ventricular and right ventricular structure, function and mechanics, as well as autonomic disbalance in patients with systemic sclerosis. Additionally, this study aimed to assess the relationship between new echocardiographic parameters and parameters of autonomic imbalance, and their relationship with parameters of periferal microangiopathy in systemic sclerosis patients. Methodology: The study included 45 systemic sclerosis patients, with no cardiovascular simptoms, who were referred to Institute of rheumatology in Belgrade and 30 age-matched healthy volunteers. All the patients underwent clinical examination, modified Rodnan skin score, serological tests, pulmonary function testing, capillaroscopy analysis, disease activity index, 24-hour ECG Holter monitoring for the heart rate variability in the time domain and frequency domain analysis. and complete two-dimensional echocardiography including strain analysis. Results: The parameters of left ventricular structure (interventricular septum thickness, relative wall thickness, left ventricular mass index, left atrial volume index, p<0.01) and right ventricular structure (right ventricular wall thickness, p<0.01) were significantly higher in systemic sclerosis patients...

sistemska skleroza, srce, ehokardiografija, mehanika, varijabilnost srĉane frekvencije, mikroangiopatija, kapilaroskopija

systemic sclerosis, heart, echocardiography, mechanics, heart rate variability, microangiopathy, capillaroscopy

616-002.77:616.12(043.3)

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