Title : Cardiac and vascular dysfunction in patients with multiple sclerosis
Abstract:
Background: Much concern was directed towards studying cardiovascular dysfunction in patients with multiple sclerosis (MS). However, the mechanisms of such dysfunction are not completely elucidated.
Aim of the work: The aim of our work was to assess cardiac and arterial functions in patients with relapsing-remitting MS and to correlate those functions with clinical and radiological findings.
Methods: This case-control study was conducted on 50 patients with MS and 50 controls. Cardiac function was assessed for all subjects using conventional two-dimensional echocardiography, tissue Doppler imaging, and Speckle Tracking. Arterial function was assessed by pulse wave velocity (PWV) and augmentation index (AIX), measured by the Brachial Cuff-Based Method via Mobil-O-Graph device. The arterial structure was also assessed by carotid IMT, using carotid ultrasound. Serum lipids were also measured in all participants.
Results: The LV systolic function was significantly decreased in MS patients, confirmed by significantly lower LV 2D ejection fraction, mitral annular plane systolic excursion, longitudinal myocardial systolic velocities, higher LV myocardial performance index, and lower LV global longitudinal strain, compared to controls. The LV diastolic function was significantly decreased in MS patients, confirmed by significantly lower mitral inflow E/A ratio, higher peak TR velocity, lower longitudinal myocardial diastolic velocities, higher mitral E/E` ratio and longer LV isovoulmetric relaxation time, compared to controls. The RV function was also significantly decreased in MS patients, confirmed by significantly lower tricuspid annular plane systolic excursion, lower longitudinal systolic and diastolic velocities, higher RV myocardial performance index and higher pulmonary artery systolic pressure, compared to controls. No significant correlation was found between cardiac function and disease duration or severity. Meanwhile, the arterial function was significantly reduced in MS patients, confirmed by significantly higher PWV and AIX, but carotid CCA IMT was similar between the two groups with no plaques in any of the patients. A significant positive correlation was found between PWV and both disease duration and disability. Serum total cholesterol and triglycerides levels were significantly higher in MS, compared to controls, while HDL-cholesterol levels were significantly lower in MS patients, compared to controls. No significant correlation was found between serum lipids and disease duration or disability.
Conclusion: Patients with MS had significantly reduced biventricular functions, in addition to significantly reduced arterial function, compared to the healthy controls. Cardiac function was not significantly correlated with disease duration or disability, in contrast to arterial function which was significantly correlated with disease duration and disability. MS patients had significantly higher serum levels of T-cholesterol and triglycerides and significantly lower serum level of HDL-cholesterol, compared to controls.
