Prevalence and risk factors for left ventricular diastolic dysfunction in a scleroderma cohort.

OBJECTIVES: Left ventricular diastolic dysfunction (LVDD) is more common in systemic sclerosis (SSc) compared to the general population. Focal myocardial ischaemia and fibrosis may be important in its pathogenesis. LVDD is associated with increased mortality and little is known about the risk factors. Advanced SSc lung complications may accompany LVDD.

METHOD: We conducted a cross-sectional study of 300 SSc outpatients with and without LVDD, seen between May 2012 and May 2014, and performed univariate and multivariate regression analyses to determine clinical factors associated with LVDD. LVDD was confirmed by the latest echocardiogram (tissue Doppler imaging) reports. Interstitial lung disease (ILD) was confirmed by high-resolution computed tomography (HRCT) and pulmonary hypertension (PH) was diagnosed by right heart catheterization (RHC).

RESULTS: Of the 300 SSc patients, there were 133 (44%) with LVDD. In the univariate analysis, advanced age, disease duration (from the onset of Raynaud's phenomenon), anti-centromere antibody, the presence of SSc lung complications, systemic hypertension, smoking, valvular heart disease, chronic kidney and thyroid diseases were all significantly associated with LVDD. However, in the multivariate regression analysis, advanced age was the most significant factor associated with LVDD, followed by systemic hypertension and SSc lung complications. There were significantly more deaths in the LVDD group (p < 0.0001).

CONCLUSIONS: LVDD was more prevalent in the SSc population, especially in those with advanced age, systemic hypertension, or SSc-pulmonary complications. SSc patients with pulmonary fibrosis or pulmonary hypertension had more advanced LVDD and higher mortality. More effective therapy is needed to improve the outcome in this population.