Original Article Cardiac Involvement in Limited Systemic Sclerosis: Non-invasive Assessment in Asymptomatic Patients R. Handa 1 , K. Gupta 1 , A. Malhotra 2 , P. Jain 3 , P. K. Kamath 3 , P. Aggarwal 1 , S. N. Dwivedi 4 and J. P. Wali 1 Departments of 1 Medicine, 2 Nuclear Medicine, 3 Cardiology and 4 Biostatistics, All India Institute of Medical Sciences, New Delhi, India Abstract: Nineteen patients with limited systemic sclerosis (SSc) and without any cardiac symptoms were evaluated non-invasively for silent cardiac in- volvement using electrocardiography; M-mode, two- dimensional and Doppler echocardiography, and resting and post exercise radionuclide ventriculography. Left anterior hemiblock and mild pericardial effusion were seen in two patients. The interventricular septal thickness and left ventricular posterior wall thickness were greater in patients compared with controls. Patients with limited SSc also exhibited low early diastolic filling velocities and a low early diastolic atrial filling ratio. However, these values did not correlate with the age of the patient or disease duration. Eight patients (42.1%) were found to have cardiac dysfunction, of which four had combined systolic and diastolic dysfunction. Isolated systolic and diastolic dysfunction was seen in three patients and one patient, respectively. The age and disease duration in patients with cardiac dysfunction did not differ from patients without cardiac dysfunction. Functional cardiac involvement occurs in a large proportion (42.1%) of patients with limited SSc, and can be easily picked up by non-invasive methods such as echocardiography and radionuclide ventriculography. The prognostic significance of these findings requires further long term studies. Keywords: Cardiac involvement; Echocardiography; Limited cutaneous systemic sclerosis; Radionuclide ventriculography; Systemic sclerosis Introduction Cardiac involvement in systemic sclerosis (SSc) may manifest as pericardial or myocardial disease. While clinically evident pericarditis is seen in 15% of cases and congestive cardiac failure in 10% of cases approximately [1,2], autopsy studies reveal a much higher incidence of pericardial (33–72%) and myocardial (12–89%) abnorm- alities [3-5]. Traditionally it has been believed that early and significant incidence of interstitial lung disease and myocardial involvement is seen in diffuse cutaneous SSc, whereas limited SSc has a low risk of visceral involvement. However, a fairly high incidence of cardiovascular abnormalities has recently been demon- strated in patients with limited SSc [6]. Because cardiac involvement may have an important bearing on prognosis, the present study was undertaken to determine non-invasively the type and extent of cardiac involve- ment in patients with limited SSc without any cardiac symptoms. Patients and Methods Nineteen consecutive patients with a diagnosis of limited SSc were included in the study after informed consent. The diagnosis of SSc was based on the American College of Rheumatology (formerly American Rheuma- tism Association) criteria [7]. Only patients with sclerosis of the face and involvement distal to the elbows and knees (limited SSc), and without any signs or symptoms suggestive of cardiac involvement were studied. These patients were drawn from a cohort of 35 patients with SSc who presented to our rheumatology Clin Rheumatol (1999) 18:136–139 ß 1999 Clinical Rheumatology Clinical Rheumatology Correspondence and offprint requests to: Dr R. Handa, Division of Rheumatology, Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029, India. Fax: 91-11-686 2663; e-mail: rhanda@medinst.ernet.in