Assessment Of Right Ventricular Systolic Function And Contractile Reserve In Patients With Connective Tissue Diseases Using Treadmill Exercise Stress Echocardiography

Objective: To evaluate right ventricular systolic function and contractile reserve using treadmill exercise stress echocardiography in patients of connective tissue disease with normal pulmonary artery pressure at rest and post-exercise.The subclinical right ventricular dysfunction was dected in those patients,To demonstrate the promising diagnostic value of early clinical diagnosis.Methods: Twenty-nine patients diagnosed with CTD and without PAH at rest and 28 healthy sex and age matched controls were enrolled.Parameters were compared at rest and post-exercise immediately with themselves at the same time.All the subjects underwent treadmill exercise-stress echocardiography.The parameters of tricuspid regurgitation(TR)at rest and post-exercises immediately;The parameters of right ventricular systolic function measured at rest and post-exercises immediately were: tricuspid annular plane systolic excursion(TAPSE),right ventricular fractional area change(FAC),peak longitudinal systolic strain(S)and systolic strain rate(S-Sr),pulsed tissue Doppler systolic velocity(s’).To compare the differences of those parameters between the two groups at different stages,as well as right ventricular contractile reserve(the difference between rest and post-exercises).Intra-and inter-observer variabilities of S and S-Sr at baseline and after exercise were analyzed.Results:(1)General clinical parameters: There was no significant different in age and baseline heart rate,systolic blood pressure,diastolic blood pressure,peak heart rate,peak systolic blood pressure,peak diastolic blood pressure and body mass index、metabolic equivalent of energey between the two groups(P>0.05).(2)Parameters at rest: there was no significant difference in left ventricular ejection fraction(EF)between the CTD group and the controls(P>0.05).TAPSE,s’ and S were significantly lower in CTD group than those of control group(P<0.05).There was no significant difference in S-Sr and FAC between the two groups(P>0.05).(3)Parameters after treadmill test: TAPSE,STRAIN,S,s’,and S-Sr were higher after exercises in both groups.Parameters s’,TAPSE,S,S-Sr,FAC were much lower in CTD groups than those of controls(P<0.05).Right ventricular contraction reserve including △s’,△S-Sr,△TAPSE,△FAC,△S were lower in CTD group than those of controls(P < 0.05).Conclusion:The right ventricular systolic function and contractile reserve after exercise are significantly impaired in patients with connective tissue disease even without resting PAH.Exercise stress echocardiography is a simple,non-invasive method for assessing cardiac function,and there might be an important clinical value in diagnosis of right ventricular systolic dysfunction and contractile reserve in at early stage of CTD patients patients who diagnosed with CTD and without PAH at rest.