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Prevalence and risk factors for left ventricular diastolic dysfunction in systemic sclerosis: a multi-center study of CRDC cohort in China

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Abstract

Objective

Left ventricular diastolic dysfunction (LVDD) is a common manifestation of cardiac involvement in systemic sclerosis (SSc), which is associated with increased mortality, but little is known about the risk factors. The aim is to determine the frequency and potential predictors of SSc-LVDD.

Methods

We conducted a prospective multi-center cohort study, enrolling 784 SSc patients assessed by echocardiography between April 2008 and June 2019. Diagnosis of systemic sclerosis was according to the 2013 American College of Rheumatology (ACR)/the European League Against Rheumatism (EULAR) classification criteria. Data were compared between patients with and without LVDD, while univariate and multivariate regression analysis was performed to determine the factors independently associated with LVDD.

Results

LV diastolic dysfunction was present in 246/784 (31.4%) of the subjects. There were no significant differences in gender, BMI, or disease duration between the two groups. Around 40% of the patients in the SSc-LVDD group and in the SSc-non LVDD group had diffused cutaneous involvements. Factors independently associated with LV diastolic dysfunction in multivariable analysis included age at onset (OR 1.053, 95%CI 1.021–1.086, p = 0.001), pulmonary arterial hypertension (OR 3.057, 95%CI 1.468–6.367, p = 0.003), positivity of anti-RNP antibody (OR 2.455, 95%CI 1.049–5.745, p = 0.038), increased WBC count (OR 1.156, 95%CI 1.037–1.287, p = 0.009), elevated levels of uric acid (OR 1.003, 95%CI 1.000–1.006, p = 0.036), and triglyceride (OR 1.515, 95%CI 1.106–2.077, p = 0.010).

Conclusion

LV diastolic dysfunction was prevalent in the SSc population. Advanced onset age, PAH, positive anti-RNP antibody, increased WBC count, and adverse metabolic status were independent risk factors for SSc-related LVDD.

Key Points

• In this Chinese multi-center cohort of systemic sclerosis, LVDD is not a rare complication, with a prevalence of 31.4%.

• The presence of advanced onset age, PAH, positive anti-RNP antibody, increased WBC count and adverse metabolic status were baseline predictors of developing LVDD in SSc.

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All data generated or analyzed during this study are included in the article.

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Acknowledgements

We thank CRDC multi-center co-authors as above for assistance with cases collections

Funding

This study was supported by the CAMS Innovation Fund for Medical Sciences (CIFMS) (2019-I2M-2–008).

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Authors and Affiliations

  1. Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China

    Min Hui, Jiaxin Zhou, Mengtao Li, Qian Wang, Jiuliang Zhao, Yong Hou, Dong Xu & Xiaofeng Zeng

  2. Department of Rheumatology, ShanXi Bethune Hospital, ShanXi Academy of Medical Sciences, Shanxi, 030000, China

    Liyun Zhang

  3. Department of Rheumatology, The Second Affiliated Hospital of Nanchang University, Jiangxi, 330006, China

    Xinwang Duan

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  1. Min Hui
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  9. Dong Xu
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Contributions

Min Hui and Jiaxin Zhou: Data curation, Writing-Original draft preparation.

Liyun Zhang and Xinwang Duan: Supervision.

Mengtao Li and Qian Wang: Visualization, Investigation.

Jiuliang Zhao: Conceptualization, Methodology, Software.

Yong Hou: Software, Validation.

Dong Xu and Xiaofeng Zeng: Writing- Reviewing and Editing.

Corresponding authors

Correspondence to Dong Xu or Xiaofeng Zeng.

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This study was approved by Chinese Rheumatism Data Center (CRDC) with the number S-478. Informed consent was obtained.

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The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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Hui, M., Zhou, J., Zhang, L. et al. Prevalence and risk factors for left ventricular diastolic dysfunction in systemic sclerosis: a multi-center study of CRDC cohort in China. Clin Rheumatol 40, 4589–4596 (2021). https://doi.org/10.1007/s10067-021-05804-6

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