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Prevalence and factors associated with left ventricular dysfunction in the EULAR Scleroderma Trial and Research group (EUSTAR) database of patients with systemic sclerosis
  1. Y Allanore1,
  2. C Meune2,
  3. M C Vonk3,
  4. P Airo4,
  5. E Hachulla5,
  6. P Caramaschi6,
  7. G Riemekasten7,
  8. F Cozzi8,
  9. L Beretta9,
  10. C T Derk10,
  11. A Komócsi11,
  12. D Farge12,
  13. A Balbir13,
  14. V Riccieri14,
  15. O Distler15,
  16. A Chialà16,
  17. N Del Papa17,
  18. K Pasalic Simic18,
  19. M Ghio19,
  20. B Stamenkovic20,
  21. S Rednic21,
  22. N Host22,
  23. R Pellerito23,
  24. E Zegers24,
  25. A Kahan1,
  26. U A Walker25,
  27. M Matucci-Cerinic26
  1. 1
    Université Paris Descartes, APHP, Hôpital Cochin, Service de Rhumatologie A, Paris, France
  2. 2
    Université Paris Descartes, APHP, Hôpital Cochin, Service de Cardiologie, Paris, France
  3. 3
    Rheumatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  4. 4
    Servizio di Reumatologia ed Immunologia Clinica, Spedali Civili, Brescia, Italia
  5. 5
    Service de Médecine Interne, Lille, France
  6. 6
    Dipartimento di Medicina Clinica e Sperimentale, Università di Verona, Verona, Italy
  7. 7
    Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie der Charité Universitätsmedizin, Berlin, Germany
  8. 8
    Rheumatology Unit, University of Padova, Padova, Italy
  9. 9
    IRCCS Fondazione Policlinico-Mangiagalli-Regina Elena and University of Milan, Milan, Italy
  10. 10
    Division of Rheumatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  11. 11
    Heart Institute, Faculty of Medicine, University of Pécs, Pécs, Hungary
  12. 12
    Service de médecine interne et pathologie vasculaire, hôpital Saint-Louis, INSERM U697, Paris, France
  13. 13
    B Shine Department of Rheumatology, Rambam Health Care Campus, Haifa, Israel
  14. 14
    Cattedra di Reumatologia, Department of Clinical and Medical Therapy, University of Rome La Sapienza, Rome, Italy
  15. 15
    University Hospital Zurich, Zurich, Switzerland
  16. 16
    DIMIMP, Sezione di Reumatologia, Università degli Studi di Bari, Italy
  17. 17
    Department of Rheumatology, G Pini Hospital, Milano, Italy
  18. 18
    Institute Rheumatology, Belgrade, Serbia
  19. 19
    Department of Internal Medicine, University and San Martino Hospital of Genoa, Genoa, Italy
  20. 20
    Department of Rheumatology, Institute for Prevention and Treatment of Rheumatic and Cardiovascular Disease Niška Banja, Medical Faculty, University of Ni, Ni, Serbia
  21. 21
    Department of Rheumatology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
  22. 22
    Department of Cardiology Y, Bispebjerg University Hospital, Copenhagen, Denmark
  23. 23
    Ospedale Mauriziano Umberto I, Torino, Italy
  24. 24
    Cardiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  25. 25
    Department of Rheumatology, Basel University, Switzerland
  26. 26
    Department of BioMedicine, Division of Rheumatology AOUC, University of Florence, Italy
  1. Correspondence to Professor Y Allanore, Service de Rhumatologie A, Hôpital Cochin, Université Paris Descartes, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; yannick.allanore{at}


Objectives: To measure the prevalence of, and factors associated with, left ventricular (LV) dysfunction in systemic sclerosis (SSc).

Methods: The EUSTAR database was first searched. A case-control study of a patient subset was then performed to further identify independent factors associated with LV dysfunction by simple and multiple regression.

Results: Of 7073 patients, 383 (5.4%) had an LV ejection fraction (EF) of <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 were associated with LV dysfunction. In the second phase, 129 patients with SSc with LVEF <55% were compared with 256 patients with SSc with normal LVEF. Male sex (OR 3.48; 95% CI 1.74 to 6.98), age (OR 1.03; 95% CI 1.01 to 1.06), digital ulcerations (OR 1.91; 95% CI 1.05 to 3.50), myositis (OR 2.88; 95% CI 1.15 to 7.19) and use of calcium channel blockers (OR 0.41; 95% CI 0.22 to 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 an increased prevalence of LV dysfunction. Conversely, the use of calcium channel blockers may be protective.

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  • ▸ Additional details of the methods and statistical analysis used and EUSTAR co-authors are published online only at

  • EUSTAR co-authors are listed in file 2 in the online supplement.

  • For numbered affiliations see end of article

  • Funding EUSTAR is supported by a research grant from EULAR and is under the auspices of the Standing Committee for International Studies Including Clinical Trials (ESCCA).

  • Competing interests None.

  • EUSTAR co-authors are listed in file 2 in the online supplement.

  • Provenance and Peer review Not commissioned; externally peer reviewed.