Subclinical right ventricular dysfunction in juvenile systemic sclerosis: a cross-sectional echocardiographic study

Objective: This study aimed to evaluate subclinical myocardial involvement in asymptomatic juvenile systemic sclerosis (JSSc) patients using conventional Doppler (CD), tissue Doppler imaging (TDI), and speckle tracking echocardiography (STE). Methods: In this cross-sectional, retrospective study, nine asymptomatic JSSc patients and ten age- and gender-matched healthy controls were evaluated. All participants underwent echocardiographic assessment, including CD, TDI, and STE, according to standardized protocols. Right and left ventricular systolic and diastolic parameters were compared between groups. Results: In JSSc patients, tricuspid E/A ratio was lower (p=0.012), deceleration time (DT) and ejection time (ET) were shorter (p=0.025, p=0.006), and myocardial performance index (MPI) was higher (p=0.025) compared to controls. TDI measurements also showed shorter ET (p=0.024) and increased MPI (p=0.002). Right ventricular end-diastolic and end-systolic volumes were significantly smaller (p=0.004, p=0.018), and right ventricular ejection fraction (RVEF) was lower (p=0.019) in JSSc patients. No significant differences were detected in right ventricular strain parameters or left ventricular global longitudinal strain (GLS) and circumferential strain (GCS) values between groups. However, TDI-derived MPI for the left ventricle was elevated in JSSc patients (p=0.018), suggesting early global dysfunction despite preserved left ventricular ejection fraction. Conclusion: Subclinical right ventricular dysfunction occurs early in JSSc, even in asymptomatic patients without pulmonary hypertension. Routine use of advanced echocardiographic techniques such as STE and TDI-derived MPI assessment may facilitate earlier detection of cardiac involvement, enabling timely intervention to improve long-term outcomes.