Speckle-tracking global longitudinal strain predicts death and cardiovascular events in patients with systemic sclerosis

• Published in: European heart journal open 2024-03, Vol.4 (2), p.oeae023-oeae023
• Main Authors: Stronati, Giulia, Guerra, Federico, Benfaremo, Devis, Dichiara, Cristina, Paolini, Federico, Bastianoni, Gianmarco, Brugiatelli, Leonardo, Alfieri, Michele, Compagnucci, Paolo, Dello Russo, Antonio, Moroncini, Gianluca
• Format: Article
• Language: English
• Subjects: Cardiac patients; Cardiovascular diseases; Cardiovascular research; Complications and side effects; Echocardiography; Health aspects; Heart diseases; Medical research; Medicine, Experimental; Mortality; Patient outcomes; Physiological aspects; Risk factors; Scleroderma (Disease); Systemic scleroderma
• ISSN: 2752-4191; 2752-4191
• DOI: 10.1093/ehjopen/oeae023

Abstract Aims Albeit often asymptomatic, heart involvement in systemic sclerosis (SSc) represents a negative prognostic factor, accounting for nearly one-fourth of all deaths. Global longitudinal strain (GLS) is accurate in detecting heart involvement in patients with SSc and no overt cardiac disease and allows early detection and longitudinal monitoring, but its association with clinical endpoints has not been tested so far. The primary outcome was the association between left and right GLS and mortality for all causes. The secondary outcome was the association between left and right GLS and hospitalizations. Methods and results A prospective longitudinal study enrolling all consecutive patients with SSc without structural heart disease or previous cardiovascular event. A total of 164 patients were enrolled, of whom 19 (11.5%) died during follow-up and 48 (29.3%) were hospitalized. Both left (LV) and right ventricle (RV) GLS at enrolment were independently associated with an increased risk of death for all causes and hospitalizations. Patients with biventricular GLS impairment, respectively, had a 4.2-, 4.9-, and 13.9-fold increased risk of death when compared with patients with only LV, only RV, or no impairment (P < 0.001). The incidence of hospitalization in patients with biventricular GLS impairment was nearly four times higher when compared with patients with only LV or only RV impairment, and nine times higher when compared with normal biventricular GLS (P < 0.001). Conclusion Biventricular GLS is associated with an increased risk of death and hospitalization in patients with SSc during a median of 3-year follow-up, acting as a reliable and accurate prognostic tool in everyday practice. Graphical Abstract Graphical Abstract All-cause death in patients with systemic sclerosis and time to death, according to left and right global longitudinal strain. GLS, global longitudinal strain; SSc, systemic sclerosis.