LVDD is Common in Patients With SSc, Not Associated With HFpEF

The results of a recent study showed abnormal diastolic function is prevalent in patients with systemic sclerosis (SSc), progresses over time, and is associated with worsening dyspnea, however, left ventricular diastolic dysfunction (LVDD) is not associated with clinical signs of heart failure.

The purpose of the study was to evaluate the burden of LVDD and heart failure with preserved ejection fraction (HFpEF) in SSc and determine the progression of LVDD over time and its importance in the prognosis of SSc.   

Participants who were enrolled in the Australian Scleroderma Cohort Study were included in the study, and LVDD was evaluated using the 2016 American Society of Echocardiography and the European Association of Cardiovascular Imaging Guidelines. The researchers used logistic regression analyses and generalized estimating equations to assess the association between LVDD and SSc disease characteristics and symptoms and signs of heart failure, respectively.

Of the 250 participants, LVDD was found in 34 (15%) participants, and 89 (40%) had indeterminate diastolic function. The researchers found an association between LVDD and breathlessness and worse functional class (p = 0.03), however they did not find an association between LVDD and clinical signs of heart failure.  

The results of the study also showed LVDD progressed over time, and there was significant worsening of parameters of left ventricular filling pressure. The researchers found no significant relationship between LVDD and mortality (p = 0.23). They concluded LVDD may be useful in explaining symptoms of SSc, even in the absence of HFpEF.

“As a counterpoint to other studies suggesting LVDD is associated with increased mortality in SSc, in the absence of other cardiac co-morbidities, we have not found a link between LVDD and increased mortality,” the researchers concluded. “We have for the first time linked contemporaneous clinical and [transthoracic echocardiogram] findings showing that LVDD is not associated with signs of heart failure but is associated with dyspnea and poorer functional status.”

–Jessica Bard

Reference:

Ross L, Patel S, Stevens W, et al. The clinical implications of left ventricular diastolic dysfunction in systemic sclerosis. Clin Exp Rheumatol. 2022;40(10):1986-1992. doi:10.55563/clinexprheumatol/irc0ih