Diastolic dysfunction more than doubles mortality risk in patients with systemic sclerosis
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Diastolic dysfunction is an independent risk factor for increased mortality risk among patients with systemic sclerosis, according to a study published in Arthritis & Rheumatology.
“[Diastolic dysfunction (DD)] is independently associated with an increased risk of mortality in patients with SSc,” Alicia M. Hinze, MD, MHS, an assistant professor in the division of rheumatology at the Mayo Clinic in Rochester, Minnesota, and colleagues wrote. “Potentially modifiable risk factors, including [coronary artery disease (CAD)] and obesity, should be addressed in patients with SSc to reduce mortality risk.”
To evaluate the impact of diastolic dysfunction (DD) on mortality in patients with systemic sclerosis (SSc), Hinze and colleagues assessed 806 patients from the Johns Hopkins Scleroderma Center Cohort, enrolled between November 2006 and November 2017. Each patient underwent at least one analyzable 2D echocardiogram (2DE) to diagnose DD. The researchers obtained DD risk factors and SSc disease characteristics, and evaluated the presence of DD in patients, through 2DEs.
The researchers used logistic regression models and Cox proportional hazards models to assess patient survival, with the models replicated in patients with complete information. Meanwhile, Cox proportional hazards models assessed mortality in patients with DD compared with those of normal function.
The researchers found DD in 18.6% of the patients. The median age was 58.4 years, and 84% were women. Independent risk factors for DD, according to the researchers, included old age (OR = 1.12; 95% CI, 1.09-1.15), CAD (OR = 3.69; 95% CI, 1.52-8.97), obesity (OR = 4.74; 95% CI, 2.57-8.74), longer SSc disease duration (OR = 1.04; 95% CI, 1.01-1.06), a diffusing capacity of the lung for carbon monoxide (DLCO) less than or equal to 60% of predicted value (OR = 2.41; 95% CI, 1.40-4.16), and a history of scleroderma renal crisis (OR = 3.18; 95% CI, 1.12-9.07).
Notably, the data found that gastrointestinal disease (OR = 0.48; 95% CI, 0.3-0.79) and anti-Scl70 antibodies (OR = 0.49; 95% CI, 0.26-0.93) were linked to a decreased risk for DD. Overall, the presence of DD in patients with SSc was independently associated with increased mortality (HR = 1.69; 95% CI, 1.07-2.68).
Among 672 patients with SSc and either DD or normal function, there were 135 deaths, with the Cox proportional hazards analysis demonstrating that patients with SSc and DD had an almost threefold increase in the risk for mortality (HR = 2.86; 95% CI, 2.03-4.01), and a more than twofold risk (HR = 2.38; 95% CI, 1.56-3.61) after adjusting for traditional DD risk factors. Obesity was reportedly associated with a more than 4.5-fold increase in the risk for DD among patients, reinforcing its status as a significant factor of mortality risk in patients with SSc, according to the researchers.
“We present the largest cohort study examining risk factors for DD in SSc, and impact of DD on mortality,” Hinze and colleagues wrote. “CAD and obesity are significant comorbidities associated with DD in SSc, which are also potentially modifiable risk factors. Given the strong association between DD and mortality, interventions targeting reduction in risk of CAD and obesity may also decrease mortality in SSc through a reduction in DD.”
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