The clinical implications of left ventricular diastolic dysfunction in systemic sclerosis

Area of Science:

• Cardiology
• Rheumatology
• Pulmonology

Background:

• Systemic sclerosis (SSc) is a complex autoimmune disease affecting multiple organs.
• Heart failure with preserved ejection fraction (HFpEF) and left ventricular diastolic dysfunction (LVDD) are increasingly recognized cardiovascular complications.
• The prevalence and prognostic significance of LVDD in SSc remain incompletely understood.

Purpose of the Study:

• To quantify the burden of LVDD and HFpEF in SSc.
• To assess the progression of LVDD over time.
• To determine the prognostic importance of LVDD in SSc.

Main Methods:

• Two hundred and twenty-five SSc participants from the Australian Scleroderma Cohort Study were assessed for LVDD using 2016 ASE/EACVI Guidelines.
• Logistic regression and generalized estimating equations analyzed associations between LVDD, SSc characteristics, and heart failure symptoms.
• Kaplan-Meier survival estimates assessed the relationship between LVDD and mortality.

Main Results:

• Fifteen percent of participants had LVDD, and 40% had indeterminate diastolic function.
• LVDD was associated with older age, hypertension, impaired systolic function, and interstitial lung disease.
• LVDD progressed over time, worsening left ventricular filling pressures and correlating with increased breathlessness and worse functional class, but not mortality.

Conclusions:

• Abnormal diastolic function is prevalent in SSc, progresses over time, and is linked to increased dyspnea.
• LVDD contributes to breathlessness in SSc, potentially explaining symptoms even without overt HFpEF.
• Further research is needed to elucidate the precise mechanisms and clinical implications of LVDD in SSc.