The association between echocardiographic findings of cardiac functions and serum adma levels in sustemic sclerosis

Purpose: SSc is a connective tissue disease that microvascular involvement leading to fibrosis with the skin, kidney,heart and internal organs. Heart is an organ which is most involved is associated with poor prognosis. Heart involvement is resulted with pericardial effusion, supraventricular and ventricular arrhythmias, conduction system defects, valve problems, myocardial ischemia, myocardial hypertrophy and heart failure may develop. PAH is a common complication.The early diagnosis of cardiopulmonary disease is important to take the necessary precautions. In our study, we aimed to provide at an early stage treatment of patients with SSc, by using non-invasive biochemical markers and tissue Doppler echocardiographic findings to identify preclinical period of PAH, the heart's diastolic and systolic dysfunction.Method: 30 SSc patients without clinical evidence of heart involvement, and 30 heathy subjects were included to the study. Systolic function of all subjects evaluated with left ventricular ejection fraction (Ef left), right ventricular ejection fraction (Ef right), right ventricular myocardial performance index (RV-MPI) and the diastolic function evaluated with mitral valve early diastolic wave (MIT-E), mitral valve late diastolic wave (MIT -A), left ventricular lateral wall tissue Doppler early diastolic wave (T left-Em), the lateral wall of the left ventricular tissue Doppler late diastolic wave (Tleft-Am), right ventricular free wall tissue Doppler early diastolic wave (Tright-E), right ventricular free wall tissue Doppler late diastolic wave (Tright-A) .Pulmonary arterial systolic pressure (PASP), and mean pulmonary arterial pressure (PAMP) were evaluated and plazma asymmetric dimetil arginin (ADMA) levels were measured and their associations with cardiac parameters were evaluated.Results: Echocardiographic parameters of the patients compared with controls and Tright-Am, PASP, EF right ,Tright E/TrightA values found significantly different. ADMA levels were significanty higher in patients than controls. ADMA levels was significantly higher in patients with active disease than inactive one (P <0.05). There were found no asociation between ADMA and Echocardiographic parameters, PASP and PAOP measurements.Conclusion: Right ventricular dysfunction and increasing PASP level may occur in with SSc without cardiac clinical finding by using tissue Doppler echocardiography. At the same time in patients with SSc and in patients with active disease ADMA levels are elevated. In patients with SSc , by recognising of cardiac involvement in preclinical stage early treatment can be provided. To reduce mortality and morbidity of the disease it is important to examine cardiac function at an early stage and to effectively control disease activity.