الفهرس 
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Abstract
Systemic sclerosis (SSc) is a connective tissue disease characterized by tissue fibrosis in the skin and internalorgans with vascular involvement. Cardiac and Pulmonary (ILD and PAH) involvements are the leading causes of morbidity and mortality, thier involvement are occult and symptoms are non specific,once clinicallyapparent , the prognosis is poor.
The study aimed to detection of early subclinical cardiopulmonary involvement in Systemic sclerosis (SSc) patientsusing in diagnosis several non invasive techniques (Pulmonary function tests (PFTs), high resolution computed tomography (HRCT) of the chest, echocardiography (ECHO) and tissue Doppler imaging (TDI)). Also serum biochemical markers were done ( transforming growth factor beta (TGF-B), vascular endothelial growth factor (VEGF) and matrix metalloproteinase 9 (MMP9)). The resultant parameters were correlated with severity of the disease.
Thirty SSc patients with asymptomatic cardiopulmonary manfestations were selected and compaired with 20 healthy controls. They were devidedintolimited (lcSSc) and diffuse (dcSSc) subtypes.
They were clinicalyand laboratory assessed, using non-invasive techniques (pulmonary function tests (FVC and DLCO), HRCT chest, standard echocardiography and TDI) and serum biomarkers (TGF-B, VEGF and MMP9) were done.
A subclinical ILD was found in 30% of SSc patients. It was detected by a decrease of DLCO < 80%confirmed by mild GGO in 26.6% usind HRCT of chestwhich is higher in dcSSc.
Reynaud’s phenomena was present in all SSc patients with a sever form in 90% of them.
High values of biomarkers regarding TGF-B, VEGF and MMP9 were higher in all SSc patients.
LV diastolic dysfunctionis frequent 83.3% of SSc patients, determined by high A, low E, low E/Aratio , prolonged deceleration time. Also , low E´ and high A´ in TDI in SSc patients.
Conclusion:
PFT especially DLCO and GGO in HRCT scan findings in asymptomatic SSc patients were seen in one third of cases, being more common in dcSSc.
Subclinical left ventricular impairment in patients withSSc can be detected. The impairment of LV function, often subclinical, worsens prognosis of SSc patients, leading toincreased risk of cardiovascular complications, allowing the early detection of LV abnormalities and the identification of patients at greater cardiovascular risk, may be a useful tool in order to provide a more accuratemanagement of SSc patients. Non-invasive echocardiographymeasurements are an excellent means ofidentifying early-stage PAH with lcSSc, low DLCO<80%, RP severity with increased VEGF level.
Systemic sclerosis (SSc) is a connective tissue disease characterized by tissue fibrosis in the skin and internalorgans with vascular involvement. Cardiac and Pulmonary (ILD and PAH) involvements are the leading causes of morbidity and mortality, thier involvement are occult and symptoms are non specific,once clinicallyapparent , the prognosis is poor.
The study aimed to detection of early subclinical cardiopulmonary involvement in Systemic sclerosis (SSc) patientsusing in diagnosis several non invasive techniques (Pulmonary function tests (PFTs), high resolution computed tomography (HRCT) of the chest, echocardiography (ECHO) and tissue Doppler imaging (TDI)). Also serum biochemical markers were done ( transforming growth factor beta (TGF-B), vascular endothelial growth factor (VEGF) and matrix metalloproteinase 9 (MMP9)). The resultant parameters were correlated with severity of the disease.
Thirty SSc patients with asymptomatic cardiopulmonary manfestations were selected and compaired with 20 healthy controls. They were devidedintolimited (lcSSc) and diffuse (dcSSc) subtypes.
They were clinicalyand laboratory assessed, using non-invasive techniques (pulmonary function tests (FVC and DLCO), HRCT chest, standard echocardiography and TDI) and serum biomarkers (TGF-B, VEGF and MMP9) were done.
A subclinical ILD was found in 30% of SSc patients. It was detected by a decrease of DLCO < 80%confirmed by mild GGO in 26.6% usind HRCT of chestwhich is higher in dcSSc.
Reynaud’s phenomena was present in all SSc patients with a sever form in 90% of them.
High values of biomarkers regarding TGF-B, VEGF and MMP9 were higher in all SSc patients.
LV diastolic dysfunctionis frequent 83.3% of SSc patients, determined by high A, low E, low E/Aratio , prolonged deceleration time. Also , low E´ and high A´ in TDI in SSc patients.
Conclusion:
PFT especially DLCO and GGO in HRCT scan findings in asymptomatic SSc patients were seen in one third of cases, being more common in dcSSc.
Subclinical left ventricular impairment in patients withSSc can be detected. The impairment of LV function, often subclinical, worsens prognosis of SSc patients, leading toincreased risk of cardiovascular complications, allowing the early detection of LV abnormalities and the identification of patients at greater cardiovascular risk, may be a useful tool in order to provide a more accuratemanagement of SSc patients. Non-invasive echocardiographymeasurements are an excellent means ofidentifying early-stage PAH with lcSSc, low DLCO<80%, RP severity with increased VEGF level.