Left Atrial Mechanics in Systemic Sclerosis

Abstract

Systemic sclerosis (SSc) is a systemic connective tissue disease characterized by inflammation and fibrosis in various organs. Cardiac manifestations of the disease are common but often clinically asymptomatic and may represent a diagnostic challenge: Left ventricular (LV) systolic dysfunction is rare in SSc, but diastolic dysfunction and the consequential heart failure with preserved ejection fraction (HFpEF) are much more frequent. They reflect the primary myocardial involvement of the disease. Many symptoms characteristic of SSc (dyspnea, leg oedema, exercise intolerance) are associated with LV diastolic dysfunction and elevated LV filling pressure. These typical symptoms of heart failure (HF), however, are often mistaken for pulmonary arterial hypertension (PAH) or interstitial lung disease, thus, HFpEF is significantly underdiagnosed in these patients. Therefore, early and reliable detection of LV diastolic dysfunction and elevated filling pressure has important diagnostic and prognostic implications in SSc. In the everyday practice, echocardiography is used for this purpose. Although multiple echocardiographic indices have been applied for the diagnosis, including E/A ratio, e’ velocity, E/e’ ratio, left atrial (LA) volume, LV hypertrophy and tricuspid regurgitation velocity, current echocardiographic criteria lack sensitivity. It is evident, that additional echocardiographic parameters are required. Recent studies have proved, that parameters of the LA function showed good correlation with the degree of diastolic dysfunction and LV filling pressure, exceeding the diagnostic power of the conventional echocardiographic parameters. Nowadays therefore, more and more attention has been focused on the analysis of the LA mechanics.