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Systolic Dysfunction in Systemic Sclerosis: Prevalence and Prognostic Implications.

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Systemic sclerosis (SSc) frequently causes systolic dysfunction in both the left ventricle (LV) and right ventricle (RV). While LV function remained stable, RV function worsened over time and predicted mortality in SSc patients.

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Area of Science:

  • Cardiology
  • Rheumatology
  • Systemic Sclerosis Research

Background:

  • Cardiac involvement is a major cause of mortality in systemic sclerosis (SSc).
  • The progression and full impact of systolic dysfunction in SSc remain incompletely understood.
  • Understanding cardiac function evolution is crucial for managing SSc patients.

Purpose of the Study:

  • To prospectively evaluate left ventricular (LV) and right ventricular (RV) systolic function in an unselected SSc cohort.
  • To assess the impact of systolic dysfunction on mortality in SSc.
  • To analyze the longitudinal changes in cardiac function in SSc.

Main Methods:

  • Inclusion of 277 SSc patients from Oslo University Hospital (2003-2016) compared to healthy controls.
  • Serial echocardiographies to assess changes in LV and RV systolic function.
  • Right heart catheterization for patients with suspected pulmonary hypertension; descriptive and regression analyses were performed.

Main Results:

  • At baseline, 12% of SSc patients had LV systolic dysfunction (ejection fraction <50%) and 24% had impaired global longitudinal strain (> -17.0%).
  • RV systolic dysfunction (tricuspid annular plane systolic excursion [TAPSE] <17 mm) was present in 10% at baseline.
  • Over a median follow-up of 3.3 years, LV function remained stable, but RV function (TAPSE) deteriorated significantly (P=0.005), reaching 15% prevalence.
  • Deteriorated RV systolic function was a significant predictor of mortality (HR 0.41, P=0.027), while LV function lost predictive significance when adjusted for RV function.

Conclusions:

  • Systolic dysfunction of both the LV and RV is a common complication in SSc patients.
  • LV systolic function is generally stable over time in SSc.
  • RV systolic function deteriorates during the disease course and is a significant predictor of mortality in SSc.