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Correspondence |

Abnormal Right Ventricular Diastolic Function May Not Be the Only Early Marker of Myocardial Involvement in Systemic Sclerosis FREE TO VIEW

Christophe Meune, MD; Yannick Allanore, MD, PhD
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René Descartes University, Cochin Hospital, Paris, France

Correspondence to: Christophe Meune, Cochin Hospital, AP-HP, Cardiology, 27 rue du Fg St.-Jacques, Paris 75014, France; e-mail: christophe.meune@cch.ap-hop-paris.fr



Chest. 2006;130(1):302. doi:10.1378/chest.130.1.302
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To the Editor:

We read with great interest the study of Lindqvist et al (August 2005)1 concerning 26 patients with systemic sclerosis (SSc) and matched control subjects. In their population of patients with SSc (mean [± SD] age, 56 ± 15 years; mean disease duration, 11.8 ± 8.7 years), they found no alterations in left ventricular (LV) systolic or diastolic function and also in right ventricular (RV) systolic function. In contrast, they demonstrated abnormal RV diastolic function. As they evaluated age-matched control subjects and investigated patients using both conventional and tissue-Doppler echocardiography, which is a modern and accurate method, their findings of alteration in RV diastolic function may be considered to be robust.

As discussed in their article,1RV involvement may have a different origin, including primary myocardial involvement, lung fibrosis, and/or pulmonary artery hypertension. Based on the absence of LV or RV systolic abnormalities and extensive lung fibrosis, they assumed that RV diastolic abnormalities are consistent solely with pulmonary artery hypertension; they also addressed a few limitations concerning the assessment of pulmonary artery pressure by resting echocardiography. However, to our knowledge, the absence of systolic abnormalities using conventional techniques does not rule out primary myocardial involvement.2Moreover, diastolic function may be altered very early in the course of SSc, and may be consistent with primary myocardial involvement.3 Even more intriguing may be the absence of LV systolic, LV diastolic, and RV systolic abnormalities. In fact, we and others have previously highlighted that patients with SSc often exhibit myocardium perfusion abnormalities in up to 100%2together with LV diastolic dysfunction,34 and also RV systolic dysfunction3; moreover, these alterations were demonstrated in both cutaneous subtypes of the disease and in patients with normal pulmonary artery pressure and early manifestations of SSc (duration of disease, < 5 years).3 The question is how to explain the absence of any alterations in both LV function and RV systolic function in the population investigated in the article by Lindqvist et al.1 What was the detailed therapeutic regimen? Did they explore patients with very recent manifestations of SSc, indicating that RV diastolic function is an early marker of heart involvement; one may therefore question the definition of disease duration (first symptom of Raynaud syndrome?). Were some patients with undifferentiated connective tissue disorder included in the study? Or does the study reflect the lack of sensitivity of their method of assessment?

Concerning this issue, while the authors evaluated RV function using tissue-Doppler echocardiography, one may wonder why they did not use myocardial velocities and strain rates determined by tissue-Doppler echocardiography to assess LV function.5 In conclusion, the study by Lindqvist et al1 does not support the absence of primary myocardial involvement in patients with SSc but raises few concerns about the methods of selection and investigation that were used.

The authors have no conflicts of interest to disclose.

Lindqvist, P, Caidahl, K, Neuman-Andersen, G, et al (2005) Disturbed right ventricular diastolic function in patients with systemic sclerosis: a Doppler tissue imaging study.Chest128,755-763. [CrossRef] [PubMed]
 
Kahan, A, Devaux, JY, Amor, B, et al Nifedipine and thallium-201 myocardial perfusion in progressive systemic sclerosis.N Engl J Med1986;314,1397-1402. [CrossRef] [PubMed]
 
Meune, C, Allanore, Y, Devaux, JY, et al High prevalence of right ventricular systolic dysfunction in early systemic sclerosis.J Rheumatol2004;31,1941-1945. [PubMed]
 
Maione, S, Cuomo, G, Giunta, A, et al Echocardiographic alterations in systemic sclerosis: a longitudinal study.Semin Arthritis Rheum2005;34,721-727. [CrossRef] [PubMed]
 
Meune, C, Allanore, Y, Pascal, O, et al Myocardial contractility is early affected in systemic sclerosis: a tissue Doppler echocardiography study.Eur J Echocardiogr2005;6,351-357. [CrossRef] [PubMed]
 

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References

Lindqvist, P, Caidahl, K, Neuman-Andersen, G, et al (2005) Disturbed right ventricular diastolic function in patients with systemic sclerosis: a Doppler tissue imaging study.Chest128,755-763. [CrossRef] [PubMed]
 
Kahan, A, Devaux, JY, Amor, B, et al Nifedipine and thallium-201 myocardial perfusion in progressive systemic sclerosis.N Engl J Med1986;314,1397-1402. [CrossRef] [PubMed]
 
Meune, C, Allanore, Y, Devaux, JY, et al High prevalence of right ventricular systolic dysfunction in early systemic sclerosis.J Rheumatol2004;31,1941-1945. [PubMed]
 
Maione, S, Cuomo, G, Giunta, A, et al Echocardiographic alterations in systemic sclerosis: a longitudinal study.Semin Arthritis Rheum2005;34,721-727. [CrossRef] [PubMed]
 
Meune, C, Allanore, Y, Pascal, O, et al Myocardial contractility is early affected in systemic sclerosis: a tissue Doppler echocardiography study.Eur J Echocardiogr2005;6,351-357. [CrossRef] [PubMed]
 
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