Early left atrial changes in patients with systemic sclerosis by two-dimensional speckle tracking echocardiography

Abstract Background Systemic Sclerosis (SSc) is an autoimmune disease that affects multiple organs 1. Primary myocardial involvement is not uncommon in SSc, with poor prognosis when symptomatic2-4. Pulmonary hypertension and right-sided affection of the heart are well-studied in SSC. Changes in the function of the left atrium (LA) in patients with SSc are early signs of left-sided affection of the heart, which has not yet been well investigated. Two-dimensional (2D) speckle tracking echocardiography (STE) is useful for detecting these early changes. Aim To assess the LA strain parameters in patients with SSC by 2D STE compared to age and sex-matched healthy subjects. Methods This study analyzed prospectively collected data from 30 consecutive SSc patients, excluding those with systemic hypertension and diabetes mellitus and a control group including 30 healthy female volunteers with a mean age of 35.6±7.7. Most SSC patients were females (28/30), with a mean age of 39±10.8. After obtaining informed consent, all participants underwent clinical evaluation and transthoracic echocardiography, including strain analysis. Results Left atrial reservoir (38.1±3.8 % vs. 45.33.7 %; p<0.001), conduit (21.82.7 % vs. 25.73.2 %; p<0.001), and contractile (16.23 % vs. 19.6±2 %; p<0.001) strain parameters were significantly reduced in the SSc population than the healthy controls. The LA stiffness index was also significantly higher in SSc patients (0.186±0.042 vs 0.138±0.018; p<0.001). The total emptying fraction (59.9±7 % vs. 64.73 %; p=0.003), expansion index (160.945.8 % vs. 185.224.1%; p=0.007), and passive emptying fraction (37.37.4 % vs. 40.7±8.5%; p=0.012) were significantly lower in SSc patients compared to the controls. However, the active emptying fraction showed no significant difference between the 2 groups. LA maximal volume was similar between the 2 groups. Conclusion Patients with systemic sclerosis demonstrate reduced LA phasic function even without LA enlargement, as compared to healthy individuals, based on 2D speckle-tracking echocardiography (STE).