Five-year follow-up of left ventricular diastolic function in systemic sclerosis patients: determinants of mortality and disease progression.
OBJECTIVE
In systemic sclerosis (SSc), left ventricular diastolic dysfunction reflects primary myocardial involvement of the disease. We aimed to assess the abnormalities of the diastolic function, analyze the characteristics of the disease progression, and investigate the prognostic value of diastolic dysfunction in SSc patients.


METHODS
A total of 34 SSc patients (57 ± 12 years, 31 female) were involved in the study. The following traditional or tissue Doppler parameters of left ventricular diastolic function were obtained: E/A, lateral E', E/E', left ventricular mass index (LVM index), and maximal left atrial (LA) volume index. Measurements were repeated after 5.5 years.


RESULTS
At baseline, diastolic dysfunction was found in 62% of the SSc patients. Follow-up time was 5.4 ± 1.2 years. A total of 6 patients died of heart failure. In univariate Cox regression analysis, age (HR = 1.08, p < 0.05), LVM index (HR = 1.07, p < 0.01), lateral E' (HR = 1.57, p = 0.05), and LA volume index (HR = 1.11, p < 0.01) were predictors of survival. During the follow-up, significant increase in LA volume index (27.5 ± 9.7 vs. 35.4 ± 10.6 cm(3)/m(2), p < 0.001) and E/E' was found (7.6 ± 2.5 vs. 8.7 ± 3.8, p < 0.05) while E' did not change (9.6 ± 2.6 vs. 9.2 ± 1.9 cm/s, NS). The increase in LA volume index showed positive correlation (r = 0.46, p < 0.05) while the decrease in E' values showed negative correlation (r = -0.54, p < 0.01) with the duration of the SSc.


CONCLUSIONS
In SSc patients, left ventricular diastolic dysfunction is highly prevalent and is associated with increased risk of mortality. Our data suggest that in the advanced phase of the disease, the myocardial fibrotic processes burns out while the increase of the filling pressure progresses continuously.
Faculty of Medicine, Heart Institute, University of Pécs, Pécs, Hungary. Electronic address: faludi.reka@pte.hu.
Réka
R
Faludi
Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary.
Gyöngyvér
G
Költő
Faculty of Medicine, 1(st) Department of Internal Medicine, University of Pécs, Pécs, Hungary.
Barbara
B
Bartos
Faculty of Medicine, Heart Institute, University of Pécs, Pécs, Hungary.
Georgina
G
Csima
Faculty of Medicine, Department of Rheumatology and Immunology, University of Pécs, Pécs, Hungary.
László
L
Czirják
Faculty of Medicine, Heart Institute, University of Pécs, Pécs, Hungary.
András
A
Komócsi
D000368:Aged; D016022:Case-Control Studies; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality*; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000503:physiopathology*
Diastolic dysfunction; Disease progression; Follow-up; Mortality; Myocardial fibrosis; Survival; Systemic sclerosis; Tissue Doppler imaging