Evaluation of left and right ventricle by two-dimensional speckle tracking echocardiography in systemic sclerosis patients without overt cardiac disease



The aim was to evaluate the left and right ventricular functions concurrently by two-dimensional speckle tracking echocardiography (STE) in systemic sclerosis (SSc) patients without overt cardiac disease.


A total of 47 patients with SSc and 36 age- and sex-matched controls were evaluated cross-sectionally. Two-dimensional STE was used to assess the longitudinal peak systolic strains (PSS) of both ventricles including apical long-axis (APLAX), apical four-chamber (4-CH), apical two-chamber (2-CH), and global longitudinal measurements. Any association of metabolic, cardiac, and inflammatory biomarkers with PSS was investigated.


The longitudinal PSS of the left ventricle [APLAX, 4-CH, 2-CH and global] were significantly lower in SSc patients than controls (− 18.2 ± 3.2 vs − 19.8 ± 2.7% p = 0.02; − 17.8 ± 3.5 vs. − 20.3 ± 3.3% p = 0.001; − 18.6 ± 3.1 vs. − 21.8 ± 3% p < 0.001; − 17.5 ± 5.7 vs. − 20.6 ± 2.7% p = 0.003, respectively). No difference was found between the groups for right ventricular strains. The longitudinal PSS-4CH correlated positively with CRP and ESR (r = 0.349, p = 0.016; r = 0.356, p = 0.014, respectively) and negatively with serum Galectin-3 (r = − 0.362, p = 0.012). Global longitudinal PSS-left ventricle (LV) correlated positively with CRP and homocysteine (r = 0.297, p = 0.043; r = 0.313, p = 0.041, respectively) and negatively with serum Galectin-3 (r = −0.314, p = 0.041). After multivariable adjustment, CRP remained the only predictor of longitudinal PSS-4CH (95% CI 0.35, 0.70, p = 0.028) and global longitudinal PSS of left ventricle (95% CI 0.004, 0.22, p = 0.043).


Biventricular evaluation of patients with SSc by two dimensional STE revealed reduced left ventricular longitudinal strains, despite preserved right ventricular strain, and no diastolic dysfunction. In SSc without overt cardiac disease, global cardiac assessment with 2DSTE is a promising method which seems to contribute to the detection of patients without clinical findings.

Key Points

Two dimensional STE revealed reduced left ventricular longitudinal strains, despite preserved right ventricular strain in SSc patients without overt cardiac disease.

CRP was the predictor of decreased longitudinal strains.

Cardiac assessment in SSc should be made globally.

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The authors are grateful to Mr. Jeremy Jones of the Academic Writing Department of Kocaeli University, Izmit, Turkey, for his assistance in editing the English language usage used and for his help and advice concerning the contents of this manuscript.

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Correspondence to Duygu Temiz Karadag.

Ethics declarations

This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by Kocaeli University School of Medicine Ethics Committee for non-invasive clinical trials with protocol number 178 and name “Evaluation of the ventricular dysfunction by two-dimensional speckle tracking echocardiography in SSc patients without pulmonary hypertension” in 16 June 2015 (KOU KAEK 2015/178).

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Informed consent was obtained from all individual participants included in the study.



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Karadag, D.T., Sahin, T., Tekeoglu, S. et al. Evaluation of left and right ventricle by two-dimensional speckle tracking echocardiography in systemic sclerosis patients without overt cardiac disease. Clin Rheumatol 39, 37–48 (2020).

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  • Left ventricle
  • Right ventricle
  • Speckle tracking echocardiography
  • Systemic sclerosis
  • Systolic dysfunction