Author + information
- Murat Sunbul1,
- Kursat Tigen1,
- Gulsen Ozen2,
- Erdal Durmus1,
- Tarik Kivrak1,
- Altug Cincin1,
- Beste Ozben1,
- Halil Atas1,
- Haner Direskeneli2 and
- Yelda Basaran1
Systemic sclerosis (SSc) is a characterized by vascular dysfunction and excessive fibrosis. Cardiac manifestations are common in SSc while in the majority of SSc patients, these manifestations may remain subclinical. The aim of the study was to evaluate regional myocardial function of SSc patients by two-dimensional (2D) speckle tracking echocardiography (STE) and to explore a relation between regional myocardial dysfunction and fragmented QRS (fQRS) complexes present in surface electrocardiography (ECG).
The study included 53 consecutive patients with SSc (6 male, mean age: 49.1±11.5 years) and 26 healthy controls (4 male, mean age: 42.8±11.7 years). All SSc patients and controls underwent a transthoracic echocardiography to evaluate left ventricular (LV) function by 2D STE and a 12-derivation ECG to check for fQRS complexes.
The fQRS was detected in 13 SSc patients (in inferior leads in 11 patients and in anterior leads in 2 patients). There were not any significant differences in conventional echocardiographic parameters between SSc patients and controls. However, SSc patients had significantly lower LV global longitudinal strain (GLS), LV global circumferential strain (GCS) and LV twist compared to controls. Additionally, SSc patients with fQRS had significantly lower LV GLS and LV GCS compared to SSc patients with normal QRS complexes although their conventional echocardiographic measures were similar (Table). The SSc patients with fQRS in inferior leads had significantly impaired longitudinal strain values in the inferior LV segments compared to SSc patients with normal QRS complexes (20.2±1.7% vs 22.8±3.3%, p=0.017).
SSc patients have regional subclinical myocardial dysfunction, which can be assessed successfully by 2D STE. Presence of fQRS in ECG is associated with lower strain measures in SSc patients indicating impaired LV function.
|SSc patients with fQRS|
|SSc patients with normal QRS|
|GLS||-19.6 ± 2.1||-21.6 ± 2.1||- 25.8 ± 2.7||<0.001 ∗,+, α|
|GRS||41.6 ± 18.3||37.9 ± 17.5||47.7 ± 7.0||0.053|
|GCS||-15.2 ± 5.1||-18.8 ± 4.9||-25.2 ± 3.3||<0.001 ∗,+, α|
|Twist||18.9 ± 5.5||16.4 ± 8.8||31.8 ± 9.4||<0.001 +, α|
Data are presented as mean ± standard deviation Posthoc analysis:
∗ p<0.05 between SSc patients with fQRS and SSc patients with normal QRS + p<0.05 between SSc patients with fQRS and controls α p<0.05 between SSc patients with normal QRS and controls SSc: Systemic sclerosis; fQRS: Fragmented QRS; GLS: Global longitudinal strain; GRS: Global radial strain; GCS: Global circumferential strain