Left Ventricular Diastolic Dysfunction Predicts Mortality in Patients With Systemic Sclerosis
| Autor: | Anna-Maria Hoffmann-Vold, Anders Heiervang Tennøe, Einar Gude, Øyvind Molberg, Torhild Garen, Arne K. Andreassen, Klaus Murbraech, Johanna Andreassen, Svend Aakhus, Håvard Fretheim |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Cardiac Catheterization medicine.medical_specialty Hypertension Pulmonary Diastole 030204 cardiovascular system & hematology Ventricular Dysfunction Left 03 medical and health sciences 0302 clinical medicine Interquartile range Internal medicine medicine Humans In patient Mortality Proportional Hazards Models Cause of death 030203 arthritis & rheumatology Heart Failure Diastolic Scleroderma Systemic Norway Proportional hazards model business.industry Middle Aged medicine.disease Pulmonary hypertension Echocardiography Doppler Cohort Cardiology Female Left ventricular diastolic dysfunction Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | Journal of the American College of Cardiology. 72:1804-1813 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/j.jacc.2018.07.068 |
| Popis: | Background Primary cardiac affection is common and is a major cause of death in systemic sclerosis (SSc), but there are knowledge gaps regarding the effect of cardiac dysfunction on mortality. Objectives The purpose of this study was to evaluate diastolic function in a large, unselected SSc cohort and assess the effect of diastolic dysfunction (DD) on mortality. Methods SSc patients followed prospectively at the Oslo University Hospital from 2003 to 2016 with available echocardiographies and matched control subjects were included. DD was assessed by echocardiography according to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. Pulmonary hypertension (PH) was diagnosed by right heart catheterization. Vital status was available for all patients. Cox regression analyses with hazards ratios (HRs) were conducted. Results Diastolic function was assessed in 275 SSc patients at baseline and in 186 patients at follow-up. At baseline, 46 of the 275 SSc patients (17%) were diagnosed with DD and 195 (71%) had normal diastolic function. After a median follow-up of 3.4 years (interquartile range: 1.6 to 6.2 years), the proportion of DD increased from 17% to 29%. During follow-up, 57% of patients with DD at baseline died, compared with 13% of patients with normal diastolic function. At baseline, 86 patients had performed right heart catheterization, and 43 were diagnosed with PH; of these 60% deceased. In multivariable Cox regression analyses, DD was a stronger predictor of death (HR: 3.7; 95% CI: 1.69 to 8.14; c-index 0.89) than PH (HR: 2.0; 95% CI: 1.1 to 3.9; c-index 0.84). Conclusions DD is frequent in SSc, and the presence of DD is associated with high mortality. DD exceeds PH with respect to predicting mortality. |
| Databáze: | OpenAIRE |
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