ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 788

Clinical and Echocardiographic Associates of All-Cause Mortality and Cardiovascular Outcomes in Patients with Systemic Sclerosis

Susanne Van Wijngaarden1, Maaike Boonstra2, Bas Bloem3, Daniela Cassani4, Felix Tanner4, Suzana Jordan5, Oliver Distler6, Martin Jan Schalij3, V. Delgado1, J.J. Bax1, Jeska de Vries-Bouwstra7 and Nina Ajmone Marsan1, 1Heart and Lung Center, Leiden University Medical Center, Leiden, Netherlands, 2Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands, 3Leiden University Medical Center, Leiden, Netherlands, 4University Heart Center, University Hospital Zurich, Zurich, Switzerland, 5Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland, 6Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland, 7Rheumatology, Leiden University Medical Center, Leiden, Netherlands

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Date: Sunday, October 21, 2018

Title: Systemic Sclerosis and Related Disorders – Clinical Poster I

Session Type: ACR Poster Session A

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

Background/Purpose:

Cardiac events are an important cause of mortality in Systemic Sclerosis (SSc), but its diagnosis remains challenging. Left ventricular global longitudinal strain is a novel parameter derived from speckle tracking echocardiographic analysis which has been proposed to identify patient at higher risk of cardiac events.We aimed to identify clinical and echocardiographic (including GLS) parameters associated with all-cause mortality and cardiovascular events in SSc patients.

Methods:

408 SSc patients (344 females, age 54±14 yrs.) were prospectively evaluated at baseline and follow-up (FU time 3.3 yrs. [IQR 1.8 to 5.5]). Cardiovascular events included: heart failure, cardiac infarction, coronary interventions, device implantation, arrhythmias, cerebral infarction, peripheral ischemic vascular disease.

Results:

All-cause mortality (n=37) or cardiovascular events (n=57) occurred in 84 patients. At baseline, these patients were older (59±14 vs. 53±14 yrs., p<0.001), more often male (24 vs. 13%, p=0.018), more often had skin pigment changes (21 vs. 5%, p=0.011), coronary artery disease (11 vs. 3%, p=0.001), holter abnormalities (45 vs. 24%, p=<0.001), increased ESR (24 [IQR 14 to 46] vs. 11 [IQR 6 to 25], p<0.001), worse NT-proBNP (151 [IQR 60 to 644] vs. 82 [IQR 51 to 145] ng/L, p<0.001), worse lung function test results (FVC 92±19 vs. 104±21%, p<0.001; DLCO 55±17 vs. 70±19%, p<0.001), worse left ventricular diastolic function (E/E-prime ratio 9.9 [IQR 6.7 to 10.2] vs. 7.8 [IQR 6.4 to 9.7], p<0.001), higher systolic pulmonary artery pressure (31±12 vs. 25±7mmHg, p<0.001) and lower GLS (-18.8 [IQR -20.3 to -19.5] vs. -21.1 [IQR -22.1 to -20.0]%, p<0.001). In a multivariate cox-regression analyses, age (HR 1.029, 95%CI 1.006 to 1.052), female sex (HR 0.527, 95%CI 0.302 to 0.922), NT-proBNP (HR 1.000, 95%CI 1.000-1.001), DLCO (HR 0.973, 95%CI 0.961-0.986) and GLS (HR 1.281, 95%CI 1.172-1.399) were independently associated with outcome. After dividing patients into groups according to median GLS (-20.9%) and elevated NT-proBNP (>200 ng/L), survival rates were lower and cardiovascular events increased when GLS was impaired and worsened when NT-proBNP was elevated (Log-rank p<0.001).

Conclusion:

In SSc patients, next to age, DLCO and NT-proBNP, GLS strongly associates with all-cause mortality and cardiovascular events, indicating that these parameters reflect relevant cardiac involvement in SSc, and as such can contribute to risk stratification and patient management.

Disclosure: S. Van Wijngaarden, None; M. Boonstra, None; B. Bloem, None; D. Cassani, None; F. Tanner, None; S. Jordan, None; O. Distler, None; M. J. Schalij, None; V. Delgado, None; J. J. Bax, None; J. de Vries-Bouwstra, None; N. Ajmone Marsan, None.

To cite this abstract in AMA style:

Van Wijngaarden S, Boonstra M, Bloem B, Cassani D, Tanner F, Jordan S, Distler O, Schalij MJ, Delgado V, Bax JJ, de Vries-Bouwstra J, Ajmone Marsan N. Clinical and Echocardiographic Associates of All-Cause Mortality and Cardiovascular Outcomes in Patients with Systemic Sclerosis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/clinical-and-echocardiographic-associates-of-all-cause-mortality-and-cardiovascular-outcomes-in-patients-with-systemic-sclerosis/. Accessed .

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