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LV diastolic dysfunction predicts mortality in patients with systemic sclerosis

10 Oct 2018

Diastolic dysfunction commonly occurs in patients with systemic sclerosis (SSc), and its presence is linked to high mortality, according to a recent study. Additionally, diastolic dysfunction is a better predictor of death as compared to pulmonary hypertension (PH).

Diastolic function was examined in 275 and 186 SSc patients at baseline and at follow-up, respectively. Of the 275 patients, 46 (17 percent) were diagnosed with diastolic dysfunction and 195 (71 percent) had normal diastolic function at baseline.

There was an increase in the proportion of diastolic dysfunction from 17 percent to 29 percent after a median follow-up of 3.4 years (interquartile range, 1.6–6.2 years). During follow-up, more than half (57 percent) of the patients with diastolic dysfunction at baseline died, compared with 13 percent of those with normal diastolic function.

Right heart catheterization was performed in 86 patients at baseline. PH was diagnosed in 43 individuals, of whom 60 percent died. Multivariable Cox regression analyses revealed that diastolic dysfunction (hazard ratio [HR], 3.7; 95 percent CI, 1.69–8.14; c-index, 0.89) was better than PH (HR, 2.0; 1.1–3.9; c-index, 0.84) in terms of predicting mortality.

This study recruited SSc patients followed prospectively at the Oslo University Hospital from 2003 to 2016 with available echocardiography results as well as matched control participants. The authors used echocardiography to assess diastolic dysfunction according to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. Right heart catheterization was used to diagnose PH. All patients had available vital status information.

“Primary cardiac affection is common and is a major cause of death in SSc, but there are knowledge gaps regarding the effect of cardiac dysfunction on mortality,” the authors noted.

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