Left Ventricular Diastolic Dysfunction Predicts Mortality in Patients With Systemic Sclerosis
Key result
Diastolic dysfunction is linked to ~270% higher mortality risk in patients with systemic sclerosis.
- HR 3.7
- 95% CI 1.69 to 8.14
- n=275
Why the study?
Primary cardiac affection is a major cause of death in systemic sclerosis, but knowledge gaps remain regarding the effect of cardiac dysfunction on mortality.
Key Points
- To determine whether left ventricular diastolic dysfunction independently predicts all-cause mortality in patients diagnosed with systemic sclerosis.
- Assessed cardiac function and diastolic parameters via echocardiography in individuals with systemic sclerosis.
- Tracked patient cohorts over clinical follow-up to evaluate survival and all-cause mortality outcomes.
- Identified left ventricular diastolic dysfunction as an independent predictor associated with reduced overall survival.
- Showed that abnormal ventricular filling profiles identify patients at elevated risk for cardiovascular and all-cause death.
Study Design
Type
Cohort (n=275)
Multicenter
No
Structured PICO
P
Population
275 patients with systemic sclerosis followed prospectively for a median of 3.4 years to assess the effect of diastolic dysfunction on mortality.
E
Exposure
Diastolic dysfunction (assessed by echocardiography according to 2016 ASE/EACVI guidelines)
C
Comparator
Normal diastolic function
O
Outcome
Mortality (death)hard clinical
Main Result
Hazard Ratio: 3.7 (95% CI 1.69–8.14)
Absolute Event Rate: 57% vs 13%
Diastolic dysfunction is frequent in systemic sclerosis and is a stronger predictor of mortality than pulmonary hypertension.
Discussion
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
CCChristian Cadeddu DessalviCardiologist, University of Cagliari
“Increased left ventricular filling pressures seem to be the crucial factor in patients with SSc. In fact, the increases in left ventricular stiffness and in filling pressures can lead to progressive remodeling of the heart, with enlargement of atrial volumes initially preceded by left atrial dysfunction”
“it is challenging to ascertain the extent to which LVDD directly affects diminished survival in adults with SSc-ILD. Specifically, it is unclear whether LVDD serves as a direct contributor to increased morbidity and mortality, or is simply a marker of longer disease duration, older age, cardiac comorbid conditions, or a more severe SSc phenotype”
MMMonica MukherjeeCardiologist, Johns Hopkins University
“the dependence on echocardiography for the screening and early detection of LVDD in SSc relies heavily on accurate and consistent reporting, which is hampered by the complexities and nuances involved in accurate diastolic assessment”
Implication
Diastolic dysfunction assessment may aid mortality risk stratification in systemic sclerosis; leaves open whether targeted intervention improves survival.
Cite This Study
Tennøe et al. (2018) conducted a cohort in Systemic sclerosis (SSc) (n=275). Diastolic dysfunction vs. Normal diastolic function was evaluated on Death (mortality) (HR 3.7, 95% CI 1.69 to 8.14). Diastolic dysfunction was a strong predictor of death in patients with systemic sclerosis (HR 3.7; 95% CI 1.69 to 8.14), with 57% mortality compared to 13% in those with normal diastolic function.