The relationship between left ventricular deformation and heart rate variability in patients with systemic sclerosis: Two- and three-dimensional strain analysis

Objective: We sought to investigate left ventricular (LV) function and deformation, as well as heart rate variability (HRV), and their relationship, in patients with systemic sclerosis (SSc). Methods: The study included 49 SSc patients and 38 age-matched healthy subjects. All patients underwent clinical examination, serological tests, 24-h Holter monitoring, and comprehensive two- and three-dimensional echocardiography (2DE and 3DE). Results: 2DE and 3DE LV global longitudinal and circumferential strain, as well as 3DE area strains are significantly reduced in SSc patients comparing with controls. 2DE and 3DE LV radial strains are similar between the observed groups. 2DE LV layer-specific longitudinal and circumferential strains are also significantly affected by SSc. Parameters of cardiac autonomic nervous system, assessed by HRV indices, SDNN, SDANN, rMMSD, p50NN, 24-h HF, LF and TP are significantly lower in SSc group. HRV indices (24-h HF and LF) are associated with 2DE LV global, 2DE LV layer-specific and 3DE LV mechanics independently of main demographic, clinical and echocardiographic parameters of the study population. Additionally, Modified Rodnan Skin Score, clinical parameter of skin involvement in SSc, is significantly associated with HRV (24-h HF and LF), 2DE and 3DE LV deformation. Conclusion: SSc significantly impacts LV deformation, all myocardial layers, and cardiac autonomic nervous function. A significant association between cardiac autonomic nervous system function, skin involvement and LV mechanics is revealed in SSc patients. These findings should encourage detailed cardiac assessment and further cardiac follow-up of the SSc patients with higher skin involvement, even when traditional echocardiographic parameters are within normal range