Charlson comorbidity index strongly correlates with subclinical myocardial dysfunction and predicts cardiovascular outcomes in patients with systemic sclerosis

Abstract

BACKGROUND: Systemic sclerosis (SSc) is a chronic inflammatory state which is associated with the development of cardiac disease. The Charlson Comorbidity Index (CCI) predicts 10-year mortality in patients with multi-system disease. This study aims to characterise the utility of CCI in populations of SSc without established cardiac disease. METHODS: Consecutive patients admitted to our institution with known history of SSc, without pre-existing cardiac disease were included for baseline and echocardiographic analysis. CCI was collected using a 17-question scoring system during index admission and a score of >=5 was deemed as high risk. These patients were followed for up for the composite outcome of all-cause death and major adverse cardiovascular events (MACE). All statistical analysis was performed using SPSS v22. RESULTS: 90 patients with SSc (57+/-13 years, 79% female) were included, and followed up for a total of 60 months, of which 21 developed a primary outcome (11 death, 10 MACE). A high CCI was strongly associated with impairment in right ventricular free wall strain (p=0.009), impairment in LV global longitudinal strain (p=0.049) and use of DMARDs (p=0.004). In this population, CCI was independently associated with the primary outcome (log-rank, p=0.001). CONCLUSION: SSc is associated with significant systemic inflammation and cardiovascular morbidity AND mortality. A high CCI can prognosticate cardiovascular outcomes in populations with SSc without established cardiac disease.