Systemic Hypertension Diminishes Left Ventricular Contractility in Patients With Systemic Sclerosis

Essential hypertension worsens left ventricular (LV) contractile function in patients with systemic sclerosis (SSc), according to study results published in The Journal of Rheumatology.

Although primary cardiac involvement is common in patients with SSc, limited data are available on the effect of traditional cardiovascular risk factors, including hypertension, on LV contractility.

The objective of the current study was to determine the impact of hypertension on LV contractility, using echocardiographic speckled-derived global longitudinal strain (GLS), calculated as the average value of longitudinal systolic strain for the 18 LV segments.

The study sample included 138 patients (87.7% women; mean age, 54.3 years) with SSc, including 56 patients with hypertension and 82 patients without hypertension. The control group included 80 patients without SSc, including 40 patients with hypertension and 40 patients without hypertension, matched by age and sex.

Even though conventional echocardiogram indicated normal LV ejection fraction, echocardiographic speckled-derived GLS showed regional and global abnormalities in LV myocardial contractility in patients with SSc.

Compared with the control participants without hypertension, patients with SSc without hypertension had decreased LV systolic function and GLS.

Patients with SSc without hypertension had lower LV ejection fraction and GLS, compared with patients without SSc and without hypertension (P <.001), mostly due to diminished regional strain of the basal and midventricular LV regional segments. Compared with control participants, patients with SSc with hypertension had worse parameters of diastolic function, including lower mitral E/A ratio (P <.05) and significantly higher septal E/e’ (P <.07).

Compared with patients with SSc without hypertension, and compared with control participants with or without hypertension, patients with SSc with hypertension had the largest reduction in GLS.  

There was no significant effect of different antihypertensive medications on GLS.

The study had several limitations, including the exclusion of patients with reduced image quality, the vendor-specific variability in strain measures, and the study design that precludes determining a cause and effect association.

“Our findings demonstrate the presence of subclinical LV contractile dysfunction in SSc that is further exacerbated by concomitant [hypertension], thereby identifying HTN as an important modifiable [cardiovascular] risk factor that should be managed aggressively in this at-risk population,” the researchers concluded.

Reference

Mercurio V, Hinze AM, Hummers LK, Wigley FM, Shah AA, Mukherjee M. Essential hypertension worsens left ventricular contractility in systemic sclerosis. J Rheumatol. Published online May 15, 2021. doi:10.3899/jrheum.200873