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Purpose: Systemic sclerosis (SSc) is an autoimmune disease with fibrosis involving heart and vessels. Impairment of longitudinal left ventricular (LV) function represents an early stage of LV systolic dysfunction occurring in SSc. Coupling between LV and vessels, particularly in the early stage of LV dysfunction, has not been properly investigated. In our study we evaluated the relationship between LV longitudinal systolic function and arterial stiffness in patients with SSc.Methods: We studied twenty-nine patients (28 female, mean age 65±4 years) affected by SSc. A standard echocardiographic study with analysis of LV longitudinal deformation, assessed by 2D strain, was performed; therefore, stiffness parameters (Pulse wave velocity - PWV, stiffness - Beta, Arterial compliance - AC) were evaluated through the study of carotid arteries using the echo-tracking technique, provided by Aloka, Japan. All patients were subdivided in two subgroups according to the median value of longitudinal strain (LS). The Student's T test and Spearman's coefficient were used to compare variables between subgroups and to evaluate correlations between variables, respectively. A p value < 0.05 was considered statistically significant.Results: All patients showed normal values of LV ejection fraction (EF) and end-diastolic/systolic volumes (EDV and ESV) [EF: 64±6 %, EDV: 83±15 ml; ESV: 33±14 ml]. LS was -13.1±4.8 % (median value -13.5 %), whereas beta, PWV and AC were, respectively, 6.5±1.5, 9.5±4.2 m/sec and 0.77±0.41 mm2/kPa. Patients with lower LS (< 13.5 %), showed a significantly increased beta (11.1±3.9 vs 8.1± 4.1, p 0.04) when compared with subjects with greater LS (> 13.5 %); no significant differences were found between the two subgroups regarding the other stiffness parameters (PWV: 6.9±1.5 vs 6.1±1.3 m/sec; AC: 0.7±0.2 vs 0.9±0.5 mm2/kPa, p ns for both). Furthermore a significant correlation was found between beta and LS (r 0.41, p 0.03).Conclusions: Impaired LS may be an early sign of abnormal LV/vessels coupling related to arterial stiffness in preclinical patients with SSc. Two-dimensional strain and echo-tracking allow, non invasively, a quantitative assessment of LV function and arterial stiffness. These techniques can be considered sensitive diagnostic tools for the early identification of abnormal LV-arterial coupling.