Cardiac involvement in systemic sclerosis: differences between clinical subsets and influence on survival.
Cardiac involvement (CI) is a known complication of SSc associated with increased mortality. Our objective was to describe a cohort of patients with SSc and CI and to assess the differences between cutaneous subsets regarding their presentation and survival. Three hundred and ninety-three Spanish patients from a single center, diagnosed with SSc, were retrospectively studied for evidence of CI using noninvasive and invasive tests from 1976 to 2011. Clinical, epidemiological, immunological and therapeutic features of patients with CI were compared to those without it and within the different cutaneous subsets of SSc. CI was present in 173 (44 %) patients. Mitral regurgitation (67 %), conduction alterations (45 %) and left ventricle diastolic dysfunction (40 %) were the most common findings. Pericardial involvement and heart failure were more frequent in diffuse SSc (dcSSc) than in limited or sine scleroderma SSc. CI accounted for 20 % of deaths, and it was an independent mortality risk factor (HR 2.1, P = 0.02), but once CI was established, classical dcSSc mortality risk factors determined mortality. Patients with dcSSc developed CI faster than limited (HR 1.9, P = 0.003) or sine SSc patients (HR 2.5, P = 0.002), specially during the first year after SSc onset. We found statistically significant differences between the 3 SSc subsets in the presentation of pericardial involvement and heart failure. CI increased the mortality and appeared at a higher rate, especially during the first year after SSc onset. Screening for heart involvement should be performed at diagnosis and during follow-up.
Department of Internal Medicine, Systemic Autoimmune Diseases Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, 3rd floot, Hospital General Vall d'Hebron building, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain. andreu.fernandez@vhebron.net.
Andreu
A
Fernández-Codina
Department of Internal Medicine, Systemic Autoimmune Diseases Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, 3rd floot, Hospital General Vall d'Hebron building, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain.
Carmen Pilar
CP
Simeón-Aznar
Department of Internal Medicine, Systemic Autoimmune Diseases Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, 3rd floot, Hospital General Vall d'Hebron building, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain.
Iago
I
Pinal-Fernandez
Cardiology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
José
J
Rodríguez-Palomares
Nuclear Medicine Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
Maria Nazarena
MN
Pizzi
Department of Internal Medicine, Systemic Autoimmune Diseases Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, 3rd floot, Hospital General Vall d'Hebron building, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain.
Cristina Eve
CE
Hidalgo
Department of Internal Medicine, Systemic Autoimmune Diseases Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, 3rd floot, Hospital General Vall d'Hebron building, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain.
Alfredo
A
Guillén-Del Castillo
Agencia de Evaluación de Tecnologías Sanitarias, Instituto de Salud Carlos III, Madrid, Spain.
Francisco Javier
FJ
Prado-Galbarro
Agencia de Evaluación de Tecnologías Sanitarias, Instituto de Salud Carlos III, Madrid, Spain.
Antonio
A
Sarria-Santamera
Department of Internal Medicine, Systemic Autoimmune Diseases Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, 3rd floot, Hospital General Vall d'Hebron building, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain.
Vicent
V
Fonollosa-Plà
Department of Internal Medicine, Systemic Autoimmune Diseases Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, 3rd floot, Hospital General Vall d'Hebron building, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain.
Miquel
M
Vilardell-Tarrés
D000328:Adult; D009202:Cardiomyopathies / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D020678:Microscopic Angioscopy; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D013030:Spain; D015996:Survival Rate
Autoimmunity; Cardiomyopathy; Fibrosis; Systemic sclerosis