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The clinical implications of left ventricular diastolic dysfunction in systemic sclerosis
L. Ross1, S. Patel2, W. Stevens3, A. Burns4, D. Prior5, A. La Gerche6, M. Nikpour7
- Department of Rheumatology, St Vincent's Hospital, Melbourne, and Department of Medicine at St Vincent's Hospital, The University of Melbourne, Australia. laura.ross@svha.org.au
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia.
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia.
- Department of Medicine at St. Vincent’s Hospital, The University of Melbourne, and Department of Cardiology, St. Vincent’s Hospital, Melbourne, Australia.
- Department of Medicine at St. Vincent’s Hospital, The University of Melbourne, and Department of Cardiology, St. Vincent’s Hospital, Melbourne, Australia.
- Department of Medicine at St. Vincent’s Hospital, The University of Melbourne, Department of Cardiology, St. Vincent’s Hospital, and Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Australia.
- Department of Rheumatology, St Vincent's Hospital, Melbourne, and Department of Medicine at St Vincent's Hospital, The University of Melbourne, Australia.
CER15999
2022 Vol.40, N°10
PI 1986, PF 1992
Full Papers
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PMID: 36259603 [PubMed]
Received: 28/06/2022
Accepted : 19/09/2022
In Press: 17/10/2022
Published: 17/10/2022
Abstract
OBJECTIVES:
We sought to quantify the burden of left ventricular diastolic dysfunction (LVDD) and heart failure with preserved ejection fraction (HFpEF) in systemic sclerosis (SSc) and assess the progression of LVDD over time and its prognostic importance.
METHODS:
Two-hundred and twenty-five participants enrolled in the Australian Scleroderma Cohort Study were included and LVDD was assessed according to 2016 ASE/EACVI Guidelines. Logistic regression analyses and generalised estimating equations were performed to evaluate the relationship between LVDD and SSc disease characteristics and symptoms and signs of heart failure, respectively. The relationship between LVDD and mortality was assessed using Kaplan-Meier survival estimates.
RESULTS:
Thirty-four (15%) participants were diagnosed with LVDD. A further 89 (40%) participants had indeterminate diastolic function. Older age (p<0.01), hypertension (p=0.02), impaired systolic function (p=0.03) and interstitial lung disease (p=0.01) were all associated with the presence of LVDD. There was no association between the presence of LVDD and clinical signs of heart failure, however, LVDD was associated with more breathlessness and worse functional class (p=0.03). LVDD was observed to progress over time, with significant worsening of parameters of left ventricular filling pressure. There was no significant relationship between LVDD and mortality (p=0.23).
CONCLUSIONS:
Abnormal diastolic function is a common finding in SSc, progresses over time and is associated with more severe dyspnoea. Whilst patients with LVDD are more breathless, LVDD is not clearly associated with clinical findings of heart failure demonstrating that LVDD may be of importance in explaining symptoms even in the absence of HFpEF in SSc.
