Prevalence, prognosis, and factors associated with left ventricular diastolic dysfunction in systemic sclerosis

Objectives: To determine the frequency, associated clinical factors, and prognostic significance of left ventricular (LV) diastolic dysfunction in systemic sclerosis (SSc). Methods: We studied 153 consecutive patients with SSc and divided the study sample into those with and without LV diastolic dysfunction using established age-based normal cut-offs for lateral tissue Doppler early mitral annular (E') velocity, a marker of impaired relaxation and diastolic dysfunction. We compared clinical characteristics, laboratory tests, pulmonary function tests, and echocardiographic data between those with and without LV diastolic dysfunction. We used multivariable linear regression analyses to determine the factors most associated with lateral tissue Doppler E' velocity. We also performed multivariable Cox regression analyses to determine whether or not tissue Doppler E' velocity was independently associated with mortality. Results: LV diastolic dysfunction was present in 23% of the subjects, whereas LV systolic dysfunction was present in 5.2% of subjects. Factors independently associated with LV diastolic dysfunction on multivariable analysis included SSc disease duration, age, coronary artery disease, and systemic hypertension. During a mean follow-up of 1.9±1.3 years, LV diastolic dysfunction was independently associated with increased risk of death (hazard ratio [HR] 3.2, 95% confidence interval [CI] 1.1-9.5, p=0.034 per each standard deviation decrease in tissue Doppler E' velocity). Conclusions: LV diastolic dysfunction in SSc is independently associated with disease duration and is a marker of increased risk of death.