High Prevalence of Right Ventricular Systolic Dysfunction in Early Systemic Sclerosis

CHRISTOPHE MEUNE, YANNICK ALLANORE, JEAN-YVES DEVAUX, ODILE DESSAULT, DENIS DUBOC, SIMON WEBER, and ANDRÉ KAHAN

ABSTRACT.

Objective. To assess right ventricular (RV) function in patients with early systemic sclerosis (SSc) and the acute effects of calcium channel blockers on RV ejection fraction (RVEF).

Methods. Forty-two consecutive patients with SSc with less than 5 years' disease duration and normal pulmonary arterial pressure (35 women, 7 men; mean age 54.3 ± 9.7 years; 16 with diffuse and 26 with limited cutaneous forms, systolic pulmonary arterial pressure 30.3 ± 5.4 mmHg) were prospectively evaluated. All underwent pulmonary function testing, echocardiography, and radionuclide ventriculography at rest and 2 hours after receiving 40 mg oral nicardipine, and were compared at baseline with 20 gender and age matched controls.

Results. None of the patients with SSc had clinical evidence of heart failure. At baseline, SSc patients had significantly lower LVEF (68.5% ± 7.9 vs 72.4% ± 5.0, p = 0.049) and RVEF (36.5% ± 7.0 vs 45.8% ± 5.7, p < 0.0001). Sixteen patients had reduced RVEF (< 35%), 3 had reduced LVEF (< 55%), and 10 had reduced peak filling rate (PFR). RVEF correlated to both LVEF and PFR (r = 0.64, p < 0.0001, and r = 0.36, p = 0.0037, respectively), whereas no correlation was found with pulmonary function impairment or pulmonary arterial pressure. Nicardipine resulted in a significant increase in RVEF (from 36.5% ± 7.0 to 42.3% ± 8.4, p < 0.001) whereas afterload indicated by mean arterial pressure did not differ significantly.

Conclusion. Reduced RVEF appears to be a common feature in early SSc; it may be due to intrinsic myocardial involvement and is acutely improved by nicardipine. (J Rheumatol 2004;31:1941-5)

Key Indexing Terms:

SYSTEMIC SCLEROSIS
RIGHT VENTRICULAR FUNCTION
LEFT VENTRICULAR FUNCTION
CALCIUM CHANNEL BLOCKERS

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From the Departments of Cardiology, Nuclear Medicine, and Rheumatology A, Cochin Hospital, APHP, Paris V University, Paris, France.

C. Meune, MD, Departments of Cardiology and Nuclear Medicine; Y. Allanore, MD, Department of Rheumatology A; J-Y. Devaux; O. Dessault, MD, Department of Nuclear Medicine; D. Duboc, MD, PhD; S. Weber, MD, PhD, Department of Cardiology; A. Kahan, MD, PhD, Department of Rheumatology A.

Address reprint requests to Professor A. Kahan, Department of Rheumatology A, Cochin Hospital, 27 rue du Fg St-Jacques, 75014 Paris, France. E-mail: andre.kahan@cch.ap-hop-paris.fr

Submitted October 16, 2003; revision accepted May 12, 2004.

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