Publication:

Cardiac involvement in systemic sclerosis- a hospital-based study in tertiary health care centre in Puducherry, India

Background Systemic sclerosis (SSc) is a complex immune-mediated condition. Systemic sclerosis related cardiac pathologies can be detected in an early stage using various imaging techniques. Aim was to study cardiac involvement in patients with systemic sclerosis.

Methods The present study was carried out as a descriptive hospital-based study of 31 patients with systemic sclerosis above 13 years of age, of either sex or who fulfilled American Rheumatism Association (ARA) diagnostic criteria. A detailed profile of lab investigations and imaging including inflammatory markers, immunological parameters, ECG and ECHO were done. Data analysis was done using SPSS (statistical package for social sciences) version 21.0. A p value <0.05 was considered statistically significant.

Results Median age of the study patients was 36 years and 90% females. Nearly 19% of the patients were classified as limited, 39% as early diffuse and 42% as late diffuse systemic sclerosis. Rheumatoid factor was positive in 19% of the patients, while antinuclear antibodies (ANA) was positive in all the patients. Pulmonary arterial hypertension (PAH) was noted in 61%. Right ventricular systolic pressure (RVSP) was relatively higher in limited SSc patients. Patients with late diffuse SSc had higher RVSP than early diffuse SSc. RV systolic function assessed by tricuspid annular plane systolic excursion (TAPSE) showed abnormally low value (<18) in five patients.

Conclusions Considerable proportion of patients with systemic sclerosis present with cardiac involvement. Tissue Doppler imaging can help in diagnosing subclinical RV dysfunction by measuring TEI index of right ventricle, which can predict PAH.