A Clinical Study Of The Cardiovascular System Function In Patients With Systemic Sclerosis By Ultrasonography

Objective:The cardiovascular system function in patients with systemic sclerosis were detected by ultrasonography to (1)investigate the clinical value of high frequency ultrasonography with E-flow imaging in the evaluation of fingertip's microcirculation changes, (2)investigate the wave intensity (WI) tracing character, (3)evaluate the clinical valve of pulmonary artery hypertension(PAH) in patients with systemic sclerosis(SSc) by echocardiography.Methods:The 24 patients were derived from the rheumatology and hematology department of Affiliated Hospital of North Sichuan Medical College from Mar 2010 to Oct 2010. They were diagnosed with systemic sclerosis(SSc) according to the SSc diagnostic criteria which was established by American Rheumatology Association in 1980. All of them had raynaud's phenomenon. 29 healthy subjects in the control group were matched in age, sex, heart rate and blood pressure with 24 SSc patients.High frequency ultrasonography with E-flow imaging was used to observe the configuration and distribution of digital arteries in the last segment of left and right middle finger. Peak systolic velocity(PSV), end diastolic velocity(EDV), mean velocity(MV), vascular resistance index(RI) and pulsatility index(PI) of digital palmar propria arteries, nail bed arteries and finger ventral arteries were measured.The right and left common carotid artery were targeted for ultrasonic imaging to obtain WI parameters which including instantaneous accelerating wave intensity(W1), instantaneous deceleration wave intensity(W2), negative area(NA), the pre-eject time(R-W1) and the eject time(W1-W2). R-W1 and W1-W2 calibrated with R-R time. And the data of stiffness parameter (β), pressure-strain elastic modulus (Ep), arterial compliance (AC), augmentation index (AI), pulse wave velocity (PWV) were recorded. Each parameter was compared between two groups.In two-dimensional echocardiography, right atrial systolic diameter(RA), left ventricular diastolic diameter(LV), right ventricular diastolic diameter(RV) and main pulmonary artery diameter (MPA) were measured. Left ventricular ejection fraction(EF) and fractional shortening(FS) were measured by M-mode echocardiography. Pulmonary valve flow velocity(VPa), right ventricular preejection period(RPEP) and right ventricular ejection period(RVET) were measured by pulse wave Doppler(PWD), also, acceleration time(AcT) was measured. Tricuspid regurgitation velocity(TRV max) and pressure gradient(PG) were measured to estimation pulmonany arterial systotic pressure(PASP).Results:1. General clinical data: 29 healthy subjects in the control group were matched in sex with 24 SSc patients. There were no statistically differences between SSc group and normal control group in age, heart rate and blood pressure(P>0.05).2. The data detected by high frequency ultrasonography with E-flow imaging: In normal control group, rich blood supply could be revealed within the fingertips. Digital palmar propria arteries, nail bed arteries and finger ventral arteries and their small branches could be displayed clearly and continuously by E-flow imaging. While in SSc patients, the definition and continuity of fingertip's small vascular flow images were not as good as that in the control group, with the distribution of blood flow markedly reduced. Compared with the control group, PSV, EDV and MV of digital palmar propria arteries, nail bed arteries, finger ventral arteries were decreased in SSc group(P<0.01), but both RI and PI were increased(P<0.05). There were no statistically significant differences between left and right fingertip's arteries index in normal control group(P>0.05). But PSV, EDV and MV of right digital palmar propria arteries in SSc group were lower than that of the left (P<0.05), whose differences bear statistic significance.3. The data detected by WI and two group comparison: W1 decreased and NA increased in SSc patients group compared with the control group, but there was no significant difference between two groups(P>0.05). There were obviously positive correlations between W1 and EF respectively in SSc group and the control group(r=0.675,0.608,both P<0.01). AI in SSc group was lower than it in the control group (P<0.05). PWV was higher than it in the control group (P<0.05).4. The data detected by chocardiography and two group comparison: Compared with the control subjects, RA, RV and PA diameter in patients with systemic sclerosis increased significantly(P<0.05～0.001). Vpa gained (P<0.05),AcT,AcT/RVET and AcT/PREP ratio decreased (P<0.01~0.05), RPEP/RVET ratio increased (P < 0.05), the difference had statistical significance. Eight of twenty-four patients were identified as having PAH(33.3%).Conclusion:1. In the SSc group, contrasted with control group, the distribution of blood flow reduced in finger tips, the velocity of blood flow decreased and RI increased. The velocity of right digital palmar propria arteries in SSc group was lower than that of the left.2. The carotid elasticity in patients with SSc was decreased. There was no conspicuous lesion about their left ventricular function.3. The pathological changes of bellows in patients with SSc could induce pulmonary artery hypertension and the morphological changes of cor dextrum system further.