ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1877

Prevalence and Risk Factors for Left Ventricular Diastolic Dysfunction in Scleroderma

Srikanth Vemulapalli1 and Vivien Hsu2, 1Graduate School of Biomedical Sciences, Rutgers University, New Brunswick, NJ, 2Medicine, Rutgers University, New Brunswick, NJ

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords:

Session Information

Date: Monday, November 9, 2015

Title: Systemic Sclerosis, Fibrosing Syndromes and Raynaud's - Clinical Aspects and Therapeutics Poster II

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Left ventricular diastolic dysfunction (LVDD) is more common in systemic sclerosis (SSc) compared to the general population (1).  Focal myocardial ischemia and fibrosis are thought to be important in its pathogenesis (2). LVDD leading to heart failure is associated with increased mortality.  Risk factors in SSc are not known, although advanced SSc lung complications may be more common (3).

Methods:   We collected clinical information from a cohort of SSc (4) outpatients seen consecutively in our Scleroderma Program.  LVDD was confirmed by the last echocardiogram (Tissue Doppler) report.  Interstitial lung disease (ILD) confirmed by high resolution chest CT (HRCT) and pulmonary hypertension (PH) diagnosed by right heart catheterization. Univariate and multivariate regression analyses were conducted to determine common factors associated with LVDD.

Results: Table 1 shows analysis of 300 patients; 133(44%) had LVDD.   Univariate analysis found patient’s advanced age, disease duration (from onset of Raynaud’s phenomenon), Anti-centromere antibody, presence of SSc lung complications, systemic hypertension, smoking, valvular heart disease, chronic kidney and thyroid diseases were commonly associated with LVDD.  However, using multivariable  regression analysis, advanced age was the most significant factor associated with LVDD, followed by systemic hypertension, and SSc lung complications.     

Conclusion:   LVDD was common in our SSc cohort with a prevalence of 44%.  Advanced age, systemic hypertension, and the presence of ILD or PH were independent risk factors for LVDD.  LVDD should be considered in any SSc patient with dyspnea.  Further research to find more effective treatment for LVDD is needed to improve outcomes in this patient population.

REFERENCES:

  1. Go AS et al.:  Circulation 2013.;27 (1): e6-e245.
  2. Faludi, R et al:Semin Arthritis Rheum. 2014; 44(2):220-7.
  3. Hinchcliff, M et al: Clin Exp Rheumatol. 2012; 30(2 Suppl 71): p. S30-7.
  4. Hoogen F et al: Arthritis Rheum. 2013; 65 (11):2737-47 and Ann Rheum. Dis. 2013; 72(11): 1747-55,         

Table 1:  Clinical characteristics in SSc patients with and without LVDD.

 

Characteristic

Absent LVDD   

(N=167)                                                                          

 Present   LVDD 

  (N=133)

 

    p-Value

Age, yrs (Mean+SD)

 

  53 + 13

  66 +   10

<0.001*

Female, n(%)

 

 141( 84)

 116(87)

0.5

BMI:      Normal,   n(%)

            Underweight

            Overweight   

            Obese

 75(45)

 14(8)

 52(31)

 28(18)

55(41)

9(7)

42(33)

27(20)

0.8

Race:    Caucasian,   n(%)

         Hispanic

         African American

         Asian

         Native American

105(63)

19(11)

22(13)

10(6)

11(7)

94(71)

8(6)

12(9)

8(6)

11(8)

0 .3

Type of Scleroderma:

      Diffuse,n(%)

        Limited

      Overlap

63(38)

54(32)

50(30)

42(32)

61(46)

30(22)

0.05

Disease Duration(years)

(Mean+SD)

12 +   8

18 +   12

<0.001*

Years of Raynaud  

 (Mean+SD)

12 +   9

18 +   13

<0.001*

mRSS (Mean+SD)

 

12 +   10

9 +   9

0.05

 

NailfoldCapillaroscopy:

N/(%)

Normal

Abnormal

61(37)

86(51)

 

51(38)

57(43)

0.3

 

Autoantibodies:

ANA,   n(%)

Anti-nucleolar

Anti-centromere

Anti-Scl70

Anti-RNA   pol 3

Anti-RNP   antibody

Anti-PMScl

147(86)

28(17)

38(22)

48(29)

13(8)

21(13)

5(2)

118(84)

15(11)

44(33)

29(22)

10(8)

14(11)

1(1)

0.9

0.16

0.04*

0.2

0.9

0.6

0.2

Pulmonary fibrosis

   Absent n(%)

   Present n(%)

 

Pulmonary Hypertension n(%)

   

81   (49)

86   (51)

18   (11)

48   (36)

85   (64)

36   (27)

0.03

<0.001

Systemic Hypertension

         n(%)

39(23)

64(48)

0.001

 

Valvular heart disease

           n(%)

27(16)

38(29)

0.01

Table 2:  Multivariate Regression Analysis for clinical characteristics associated with LVDD

  

   

  

b*    

  

   

  

p-value    

Crude OR

(95% CI)

Adjusted OR

(95% CI)

 

P -value

  

   

  

Age    

0.308113

0.000003

1.60   (1.50-1.70)

1.39 (1.26 – 1.52)

<0.001

  

   

  

Disease Duration    

0.146509

0.192798

 

 

 

  

   

  

Duration of Raynaud (yrs)    

-0.052186

0.635159

 

 

 

  

   

  

Systemic Hypertension    

0.150522

0.00853

.30   (1.16-1.46)

1.16   (1.04-1.30)

<0.01

  

   

  

Smoking history    

0.088763

0.099324

 

 

 

  

   

  

Thyroid disease    

-0.038341

0.501586

 

 

 

  

   

  

Valvular heart disease    

0.052880

0.339044

 

 

 

  

   

  

Renal disease    

0.053526

0.325202

 

 

 

  

   

  

Pulmonary fibrosis    

0.120043

0.03971

1.13   (1.01-1.27)

1.13   (1.01-1.26)

    < 0.04

  

   

  

Pulmonary hypertension    

0.133191

0.01769

1.23   (1.10 – 1.38)

1.16   (1.02 – 1.27)

<0.02

  

   

  

Anti-Centromere    

0.086025

0.162729

 

 

 

Disclosure: S. Vemulapalli, None; V. Hsu, None.

To cite this abstract in AMA style:

Vemulapalli S, Hsu V. Prevalence and Risk Factors for Left Ventricular Diastolic Dysfunction in Scleroderma [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/prevalence-and-risk-factors-for-left-ventricular-diastolic-dysfunction-in-scleroderma/. Accessed .

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