Mitochondrial Dysregulation and Molecular Signaling in Systemic Sclerosis Cardiac Disease: An Integrative Echocardiographic, Microvascular, and Biomarker Review

Abstract Cardiac involvement in systemic sclerosis (SSc) is mechanistically heterogeneous, driven by concurrently operative processes spanning right ventricular dysfunction, pulmonary microvascular remodeling, and mitochondrial damage. The existing literature rarely syn- thesizes these domains simultaneously, leaving substantive gaps in mechanistic under- standing and the clinical management of SSc cardiac disease. An integrative review of original primary research was conducted using PubMed, Scopus, and Web of Science. Search terms combined “systemic sclerosis,” “right ventricular dysfunction,” “echocar- diographic strain,” “pulmonary microvascular disease,” “nailfold capillaroscopy,” “mi- tochondrial dysfunction,” “oxidative stress,” and “cardiac biomarkers.” Eligible articles were required to report original empirical findings in SSc or SSc-related pulmonary arte- rial hypertension populations, encompassing echocardiographic, microvascular, molecu- lar, or biomarker outcomes. Right ventricular function is compromised across multipl