Subclinical myocardial dysfunction is associated with the development of primary cardiovascular outcomes in patients with systemic sclerosis

Abstract

BACKGROUND: Systemic sclerosis (SSc) is a chronic autoimmune condition associated with subclinical myocardial dysfunction. Myocardial strain analysis can predict cardiovascular events in multiple cardiac pathologies. The aim of this study was to assess the prognostic relevance of left ventricular global longitudinal strain (LV-GLS) and right ventricular free wall strain (RV-FWS) in patients with SSc. METHODS: Consecutive patients admitted to our institution with a known history of SSc, without established cardiac disease were included, and followed up for the development of all-cause death and major adverse cardiovascular events (MACE). GLS was performed using TomTec-Arena, Germany v4.6. LV-GLS <-17% and RV-FWS <-23% was considered abnormal. All statistical analysis was performed using SPSS v22. RESULTS: 70 patients (57+/-13 years, 79% female) with complete transthoracic echocardiograms were included. The cohort had a mean LVEF of 63+/-8%, mean TAPSE of 2.0+/-0.5 and a mean mPASP of 33+/-19mmHG. Upon 60 months of follow-up, 21 patients met the primary endpoint (11 death, 10 MACE). 25 patients demonstrated subclinical biventricular impairment (LV-GLS<-17% AND RV-FWS<-23%). The presence of subclinical biventricular impairment was associated with the primary outcome (log-rank, p=0.009). CONCLUSION: Subclinical biventricular dysfunction portends a poor prognosis in patients with SSc. Aggressive anti-remodeling and immunosuppressive therapy in this subgroup may improve their prognosis.