The effect of cold stress on right ventricular function in patients with systemic sclerosis

Year 2018, Volume: 31 Issue: 3, 94 - 100, 31.10.2018

Mustafa Yılmaztepe Meryem Aktoz Ersan Tatlı Armağan Altun

https://doi.org/10.5472/marumj.472397

Abstract

Objective: Pulmonary hypertension and right heart failure are poor

prognostic factors in systemic sclerosis (SSc). The effect of cold

stress on pulmonary vasospasm was evaluated in some trials but

the results were conflicting. The aim of our study was to determine

the effect of cold stress on right ventricular (RV) functions.

Materials and Methods: Twenty-four patients with SSc and

24 age and sex-matched healthy controls were enrolled in the

study. Transthoracic echocardiography (TTE) was performed to all

patients at rest and after peripheral cold exposure. Baseline and

after cold stress test TTE were compared between the groups.

Results: Cold exposure induced changes in particularly right

venticular functions. Pulmonary acceleration time was significantly

shortened in the SSc group (118.8±11.7ms vs 111.3±13.7ms,

P<0.001). Tricuspid annular plane systolic excurison and RV

fractional area change were also decreased after cold exposure

in the SSc group. (23.3±1.6mm vs 21.9±1.9 mm, P<0.001;

46.3±5.8 vs 44.4±5.8,P= 0.007, consecutively). Left ventricular

(LV) functions did not change after cold stress (LV myocardial

performance index (0.42± 0.04 vs 0.42± 0.05), P= 0.748).

Conclusion: Peripheral cold exposure caused a reduction

in right ventricular functions indicating pulmonary Raynaud’s

phenomenon as a possible contributing factor.

Keywords

Systemic sclerosis, Echocardiography, Tissue Doppler

Skleroderma hastalarında soğuk stresin sağ ventrikülün fonksiyonu üzerine etkisi

Abstract

Amaç: Skleroderma (SSc)’da, pulmoner hipertansiyon ve sağ

kalp yetersizliği kötü prognoz göstergesidir. SSc’da soğuk stresin

pulmoner vazospazm üzerine etkisi ile ilgili çeşitli çalışmalar

yapılmış ancak sonuçlar çelişkili çıkmıştır. Bu çalışma ile SSc

hastalarında periferik soğuk stresin sağ ventrikül fonksiyonlarına

etkisini araştırmayı amaçladık.

Gereç ve Yöntem: Yirmi dördü sklerodermalı, 24’ü sağlıklı

toplam 48 kişi çalışmaya alındı. Her iki gruba istirahat ve periferik

soğuk stres uygulama sonrasında transtorasik ekokardiyografi

yapıldı. İstirahat ve soğuk stres sonrası sol ve sağ ventrikül

fonksiyonları karşılaştırıldı.

Bulgular: Soğuk stresin özellikle sağ ventrikül fonksiyonlarında

değişikliğe yol açtığı görüldü. Pulmoner akselerasyon zamanı

skleroderma grubunda anlamlı olarak kısaldı (118.8±11.7ms vs

111.3±13.7ms, P<0.001). Triküspid anuler düzlem sistolik hareketi

ve sağ ventrikül fraksiyonel alan değişimi de soğuk stres ile azaldı

(23.3±1.6mm vs 21.9±1.9 mm, P<0.001; 46.3±5.8 vs 44.4±5.8,P=

0.007, sırasıyla). Soğuk stres ile sol ventrikül fonksiyonlarında

değişiklik saptanmadı (sol ventrikül miyokard performans indeksi

(0.42± 0.04 vs 0.42± 0.05), P= 0.748).

Sonuç: Periferik soğuk stres, sağ ventrikül fonksyonlarında

azalmaya sebep olmuştur ve bu da pulmoner Raynaud fenomeninin

pulmoner hipertansiyon gelişmesinde etken faktörlerden biri

olabileceğini düşündürmektedir.

Keywords

Sistemik skleroz, Ekokardiografi, Doku Doppler, Sağ ventrikül fonksiyonları

References

• 1. Mukerjee D, St George D, Coleiro B, et al. Prevalence and outcome in systemic sclerosis associated pulmonary arterial hypertension: application of a registry approach. Ann Rheum Dis 2003;62:1088-93.
• 2. D’Angelo WA, Fries JF, Masi AT, et al. Pathologic observations in systemic sclerosis (scleroderma). A study of fifty-eight autopsy cases and fifty-eight matched controls. Am J Med 1969;46:428-40.
• 3. Clements PJ, Furst DE. Heart involvement in systemic sclerosis. Clin Dermatol 1994;12:267-75.
• 4. Gashouta MA, Humbert M, Hassoun PM. Update in systemic sclerosis-associated pulmonary arterial hypertension. Presse Med 2014;43(10 Pt 2):e293-304. doi: 10.1016/j. lpm.2014.06.007
• 5. Steen VD. Clinical manifestations of systemic sclerosis. Semin Cutan Med Surg 1998;17:48-54.
• 6. Keir GJ, Nair A, Giannarou S, et al. Pulmonary vasospasm in systemic sclerosis: noninvasive techniques for detection. Pulm Circ 2015;5:498-505. doi: 10.1086/682221
• 7. Wise RA, Wigley F, Newball HH, et al. The effect of cold exposure on diffusing capacity in patients with Raynaud’s phenomenon. Chest 1982;81:695-8.
• 8. Sakamoto K, Houya I, Inoue K, et al. An imbalance in plasma prostanoids in patients with Raynaud’s phenomenon and pulmonary vasospasm. Eur Respir J 1999;13:137-44.
• 9. LeRoy EC, Black C, Fleischmajer R, et al. Scleroderma (systemic sclerosis): classification, subsets and pathogenesis. J Rheumatol 1988;15:202-5.
• 10. Shuck JW, Oetgen WJ, Tesar JT. Pulmonary vascular response during Raynaud’s phenomenon in progressive systemic sclerosis. Am J Med 1985;78:221-7.
• 11. Mukerjee D, Yap LB, Ong V, et al. The myth of pulmonary Raynaud’s phenomenon: the contribution of pulmonary arterial vasospasm in patients with systemic sclerosis related pulmonary arterial hypertension. Ann Rheum Dis 2004;63:1627-31. doi: 10.1136/ard.2003.015289
• 12. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015;16:233-70. doi: 10.1093/ehjci/jev014
• 13. Wang YC, Huang CH, Tu YK. Pulmonary Hypertension and Pulmonary Artery Acceleration Time: A Systematic Review and Meta-Analysis. J Am Soc Echocardiogr 2018;31:201-10. e3. doi: 10.1016/j.echo.2017.10.016
• 14. Ferri C, Giuggioli D, Sebastiani M, et al. Heart involvement and systemic sclerosis. Lupus 2005;14:702-7.
• 15. Agoston G, Gargani L, Miglioranza MH, et al. Left atrial dysfunction detected by speckle tracking in patients with systemic sclerosis. Cardiovasc Ultrasound 2014;12:30. doi: 10.1186/1476-7120-12-30
• 16. Ucar Elalmis O, Cicekcioglu H, Karagoz A, et al. Evaluation of aortic elastic properties in patients with systemic sclerosis. Turk Kardiyol Dern Ars 2014;42:635-42. doi: 10.5543/ tkda.2014.03162
• 17. Poanta L, Dadu R, Tiboc C, et al. Systolic and diastolic function in patients with systemic sclerosis. Eur J Intern Med 2009;20:378-82. doi: 10.1016/j.ejim.2008.10.011
• 18. D’Andrea A, Stisi S, Caso P, et al. Associations between left ventricular myocardial involvement and endothelial dysfunction in systemic sclerosis: noninvasive assessment in asymptomatic patients. Echocardiography 2007;24:587-97. doi: 10.1111/j.1540-8175.2007.00436.x
• 19. Can I, Onat AM, Aytemir K, et al. Detecting subclinical biventricular impairment in scleroderma patients by use of pulsed-wave tissue Doppler imaging. Tex Heart Inst J 2009;36:31-7.
• 20. Spethmann S, Rieper K, Riemekasten G, et al. Echocardiographic follow-up of patients with systemic sclerosis by 2D speckle tracking echocardiography of the left ventricle. Cardiovasc Ultrasound 2014;12:13. doi: 10.1186/1476-7120-12-13
• 21. Faludi R, Kolto G, Bartos B, et al. Five-year follow-up of left ventricular diastolic function in systemic sclerosis patients: determinants of mortality and disease progression. Semin Arthritis Rheum 2014;44:220-7. doi: 10.1016/j. semarthrit.2014.04.001
• 22. Saito M, Wright L, Negishi K, et al. Mechanics and prognostic value of left and right ventricular dysfunction in patients with systemic sclerosis. Eur Heart J Cardiovasc Imaging 2017 doi: 10.1093/ehjci/jex147
• 23. Durmus E, Sunbul M, Tigen K, et al. Right ventricular and atrial functions in systemic sclerosis patients without pulmonary hypertension. Speckle-tracking echocardiographic study. Herz 2015;40:709-15. doi: 10.1007/s00059-014-4113-2 100 Yılmaztepe et al. Effect of cold stress on the right heart in scleroderma Marmara Medical Journal 2018; 31: 94-100
• 24. Huez S, Roufosse F, Vachiery JL, et al. Isolated right ventricular dysfunction in systemic sclerosis: latent pulmonary hypertension? Eur Respir J 2007;30:928-36. doi: 10.1183/09031936.00025607
• 25. Lindqvist P, Caidahl K, Neuman-Andersen G, et al. Disturbed right ventricular diastolic function in patients with systemic sclerosis: a Doppler tissue imaging study. Chest 2005;128:755-63. doi: 10.1378/chest.128.2.755
• 26. Cannon PJ, Hassar M, Case DB, et al. The relationship of hypertension and renal failure in scleroderma (progressive systemic sclerosis) to structural and functional abnormalities of the renal cortical circulation. Medicine (Baltimore) 1974;53:1-46.
• 27. Alexander EL, Firestein GS, Weiss JL, et al. Reversible coldinduced abnormalities in myocardial perfusion and function in systemic sclerosis. Ann Intern Med 1986;105:661-8.
• 28. Gustafsson R, Mannting F, Kazzam E, et al. Cold-induced reversible myocardial ischaemia in systemic sclerosis. Lancet 1989;2(8661):475-9.
• 29. Mizuno R, Fujimoto S, Saito Y, et al. Cardiac Raynaud’s phenomenon induced by cold provocation as a predictor of long-term left ventricular dysfunction and remodelling in systemic sclerosis: 7-year follow-up study. Eur J Heart Fail 2010;12:268-75. doi: 10.1093/eurjhf/hfp198
• 30. Quarta S, Galea N, Gigante A, et al. The cardiac magnetic resonance in the diagnosis of cardiac Raynaud phenomenon in a patient with systemic sclerosis: case report and review of literature. Expert Rev Clin Immunol 2016;12:251-5. doi: 10.1586/1744666X.2016.1134320
• 31. Crosswhite P, Sun Z. Inhibition of phosphodiesterase-1 attenuates cold-induced pulmonary hypertension. Hypertension 2013;61:585-92. doi: 10.1161/ HYPERTENSIONAHA.111.00676
• 32. Fahey PJ, Utell MJ, Condemi JJ, et al. Raynaud’s phenomenon of the lung. Am J Med 1984;76(2):263-9.
• 33. Barr WG, Fahey PJ. Reduction of pulmonary capillary blood volume following cold exposure in patients with Raynaud’s phenomenon. Chest 1988;94:1195-9.
• 34. Lampert E, Charloux A, Lonsdorfer J, et al. The concept of Raynaud’s phenomenon of the lung revisited. Am J Med 1996;101:468-71.