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Right atrial morphology and function in patients with systemic sclerosis compared to healthy controls: a two-dimensional strain study

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Abstract

Enlargement and dysfunction of the right atrium might be an early sign for pulmonary hypertension in systemic sclerosis (SSc). This is the first study to analyse right atrial morphology and function in SSc patients compared to healthy controls by speckle-tracking two-dimensional strain echocardiography (2DSE) at rest and during exercise. Furthermore, right atrial function was correlated with further clinical findings. Adult patients with SSc for >3 years (n = 90) and 55 age- and gender-matched healthy controls underwent a panel of non-invasive assessments including transthoracic echocardiography, pulsed Doppler myocardial imaging and 2DSE at rest and during exercise. Furthermore, serological tests and high-resolution chest computed tomography were performed. SSc patients showed significant impairment of right atrial function and the right atrial enlargement, measured by 2DSE at rest and during exercise compared to controls (both p < 0.001). These findings were more evident in SSc patients with pulmonary fibrosis (p < 0.001) and in patients with high pulmonary artery systolic pressures (PAPs) during exercise. In the SSC patients, right atrial lateral strain was significantly associated with PAPs during effort, right atrial area, left ventricle stroke volume and inferior vena cava diameter using multivariable analysis. The findings of this study suggest that a high proportion of SSc patients reveal right atrial dysfunction even without manifest pulmonary hypertension. Impaired right atrial function occurred mostly in patients with pulmonary fibrosis and/or elevated PAPs during exercise, was independently associated with prognostic factors and may therefore be useful for risk stratification. Further studies are needed to analyse if right atrial dysfunction assessed by 2DSE may help to improve early diagnosis of pulmonary hypertension.

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Authors’ contributions

Serena Vettori, Emanuele Romeo, Paola Argiento and Marco Di Maio helped to acquire the clinical data and to perform the interpretation of the data. Rosangela Cocchia, Giovanni Maria De Marco, Michele D’Alto and Antonello D’Andrea helped to acquire the echocardiographic data and to perform the off-line interpretation of the data. Nicola Ehlken and Eduardo Bossone performed the statistical analysis and helped to perform the interpretation of the data. Ekkehard Grunig, Raffaele Calabrò, Maria Giovanna Russo and Gabriele Valentini helped to perform the design of the study and the interpretation of the data. All authors have made substantial contributions to conception and design, have been involved in drafting the manuscript and revised it critically for important intellectual content, have given final approval of the version to be published, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Authors and Affiliations

  1. Department of Cardiology, Second University of Naples – AORN dei Colli - Monaldi Hospital, Naples, Italy

    Antonello D’Andrea, Michele D’Alto, Marco Di Maio, Rosangela Cocchia, Paola Argiento, Emanuele Romeo, Giovanni Di Marco, Maria Giovanna Russo & Raffaele Calabrò

  2. Unit of Rheumatology, Second University of Naples, Naples, Italy

    Serena Vettori & Gabriele Valentini

  3. Centre for Pulmonary Hypertension Thoraxclinic, University Hospital Heidelberg, Heidelberg, Germany

    Nicola Benjamin & Ekkehard Grünig

  4. Department of Cardiology and Cardiac Surgery, University Hospital “Scuola Medica Salernitana”, Salerno, Italy

    Eduardo Bossone

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  1. Antonello D’Andrea
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  2. Michele D’Alto
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  3. Marco Di Maio
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  9. Giovanni Di Marco
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  14. Ekkehard Grünig
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Correspondence to Antonello D’Andrea.

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D’Andrea, A., D’Alto, M., Di Maio, M. et al. Right atrial morphology and function in patients with systemic sclerosis compared to healthy controls: a two-dimensional strain study. Clin Rheumatol 35, 1733–1742 (2016). https://doi.org/10.1007/s10067-016-3279-9

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  • DOI: https://doi.org/10.1007/s10067-016-3279-9

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