Prevalence and factors associated with left ventricular dysfunction in the EULAR Scleroderma Trial and Research group (EUSTAR) database of systemic sclerosis patients

Y Allanore ^1*, C Meune ², M C Vonk ³, P Airo ⁴, E Hachulla ⁵, P Caramaschi ⁶, G Riemekasten ⁷, F Cozzi ⁸, L Beretta ⁹, C T Derk ¹⁰, A Komósi ¹¹, D Farge ¹², A Balbir ¹³, V Riccieri ¹⁴, O Distler ¹⁵, A Chialà ¹⁶, N del papa ¹⁷, K Simic Pasalic ¹⁸, M Ghio ¹⁹, B Stamenkovic ²⁰, S Rednic ²¹, N Host ²², R Pellerito ²³, E Zegers ²⁴, A Kahan ¹, U A Walker ²⁵ and M Matucci-Cerinic ²⁶

¹ Université Paris Descartes; APHP; Hôpital Cochin, Service de Rhumatologie A, Paris, France
² Université Paris Descartes ;APHP ; Hôpital Cochin, Service de Cardiologie, Paris, France
³ Reumatology, Radboud University Nijmegen Medical Centre, huispost 470, PB 91016500 HB Nijmegen, Netherlands
⁴ Servizio di Reumatologia ed Immunologia Clinica, Spedali Civili, Brescia, Italy
⁵ Service de Médecine Interne, Lille, France
⁶ Dipartimento di Medicina Clinica e Sperimentale, Università di Verona, Policlinico G.B. Rossi, Italy
⁷ Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie der Charité Universität, Germany
⁸ Rheumatology Unit, University of Padova, Via Giustiniani 2-35128 Padova, Italy
⁹ IRCCS Fondazione Policlinico-Mangiagalli-Regina Elena and University of Milan, Milan, Italy
¹⁰ Division of Rheumatology, Thomas Jefferson University, 613 Curtis Bldg, Philadelphia, United States
¹¹ Heart Institute, Faculty of Medicine, University of Pécs, 13. Ifjuság Str., H-7623 Pécs, Hungary
¹² Service de médecine interne et pathologie vasculaire, hôpital Saint-Louis, INSERM U697, Paris, France
¹³ B. Shine Department of Rheumatology, Rambam Health Care Campus, Haifa, Israel
¹⁴ Cattedra di Reumatologia, Department of Clinical and Medical Therapy, University of Rome La Sapienza, Italy
¹⁵ University Hospital Zurich, Zurich, Switzerland
¹⁶ DIMIMP, Sezione di Reumatologia, Università degli Studi di Bari, Italy
¹⁷ Department of Rheumatology, G. Pini Hospital, Milano, Italy
¹⁸ Institute Rheumatology, Belgrade, Serbia and Montenegro
¹⁹ Department of Internal Medicine, University and San Martino Hospital of Genoa, Genoa, Italy
²⁰ Institute for Prevention and Treatment of Rheumatic and Cardiovascular Disease Ni ka Banja, Serbia and Montenegro
²¹ Department of Rheumatology, Romania
²² Department of Cardiology Y, Bispebjerg University Hospital, DK-2400 Copenhagen, Denmark
²³ Ospedale Mauriziano Umberto I, Largo Turati 62, 10128 Torino, Italy
²⁴ Cardiology, Radboud University Nijmegen Medical Centre, huispost 470, PB 91016500 HB Nijmegen, Netherlands
²⁵ Medizinische Universitätsklinik Freiburg, Switzerland
²⁶ Department of BioMedicine, Division of Rheumatology AOUC, University of Florence, Italy

^* To whom correspondence should be addressed. E-mail: yannick.allanore{at}cch.aphp.fr.

Accepted 23 February 2009

Abstract

Study objectives and methods: To measure the prevalence of, and factors associated with, left ventricular (LV) dysfunction in SSc, we first queried the EUSTAR database. In a second phase, we performed a case-control study of a patient subset, to further identify independent factors associated with LV dysfunction by simple and multiple regression.

Results: Among 7,073 patients, 383 (5.4%) had a LV ejection fraction (EF) <55%. By multiple regression analysis, age, sex, diffuse cutaneous disease, disease duration, digital ulcerations, renal and muscle involvement, disease activity score, pulmonary fibrosis and pulmonary arterial hypertension (PAH) were associated with LV dysfunction. In a second phase, 129 SSc patients with LVEF <55% were compared with 256 SSc patients with normal LVEF. Male sex (OR 3.48; 95% CI1.74-6.98), age (OR 1.03; 95% CI 1.01-1.06), digital ulcerations (OR 1.91; 95% CI 1.05-3.50), myositis (OR 2.88; 95% CI 1.15-7.19), and calcium channel blockers (CCB) use (OR 0.41; 95% CI 0.22-0.74) were independent factors associated with LV dysfunction.

Conclusion: The prevalence of LV dysfunction in SSc is 5.4%. Age, male gender, digital ulcerations, myositis and lung involvement are independently associated with increased prevalence of LV dysfunction. Conversely, CCB use may appear as protective.