First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 47 Ziołowa St., 40-635, Katowice, Poland.
Upper Silesia Medical Centre, Katowice, Poland.
Sci Rep. 2021 Oct 1;11(1):19598. doi: 10.1038/s41598-021-99215-x.
The aim of the study was to assess the predictors of major adverse cardiovascular events (MACE) in patients with systemic sclerosis (SSc) without pulmonary arterial hypertension. The study comprised 68 patients with SSc who were followed up for the median time of 99 (96; 107) months. The main exclusion criteria involved tricuspid regurgitation maximal velocity > 2.8 m/s and structural heart disease. At baseline the patients underwent clinical assessment of cardiovascular risk factors, 6-min walk test, transthoracic echocardiography and biomarker testing, including growth differentiation factor 15 (GDF-15). The primary composite endpoint was onset of MACE defined as death, myocardial infarction, myocardial revascularization and hospitalization for heart failure. The follow-up consisted of outpatient visits at 1 year intervals and telephone interview every 6 months. The baseline analysis revealed that chronic kidney disease (HR 28.13, 95%CI 4.84-163.38), lung fibrosis on high resolution computed tomography (HR 4.36, 95%CI 1.04-18.26) and GDF-15 concentration (unit HR 1.0006, 95%CI 1.0002-1.0010) were independent predictors of MACE occurrence. CHLD (Chronic kidney disease, Hypertension, hyperLipidaemia, Diabetes mellitus) score was formulated which assigned 1 point for the presence of arterial hypertension, hyperlipidaemia, diabetes mellitus and chronic kidney disease. After inclusion of CHLD score in Cox proportional model, it remained the only independent predictor of MACE onset (unit HR per 1 point 3.46; 95%CI 2.06-5.82, p < 0.0001). Joint assessment of traditional risk factors in the form of CHLD score may serve as a reliable predictor of long-term outcome in patients with SSc without pulmonary arterial hypertension.
研究目的在于评估无肺动脉高压系统性硬化症（SSc）患者发生主要不良心血管事件（MACE）的预测因子。该研究纳入了 68 例 SSc 患者，中位随访时间为 99（96；107）个月。主要排除标准为三尖瓣反流最大速度>2.8 m/s 和结构性心脏病。基线时，患者接受了心血管危险因素的临床评估、6 分钟步行试验、经胸超声心动图和生物标志物检测，包括生长分化因子 15（GDF-15）。主要复合终点是 MACE 的发生，定义为死亡、心肌梗死、心肌血运重建和心力衰竭住院。随访包括每年 1 次门诊就诊和每 6 个月 1 次电话访谈。基线分析显示，慢性肾脏病（HR 28.13，95%CI 4.84-163.38）、高分辨率计算机断层扫描（HR 4.36，95%CI 1.04-18.26）的肺纤维化和 GDF-15 浓度（单位 HR 1.0006，95%CI 1.0002-1.0010）是 MACE 发生的独立预测因子。CHLD（慢性肾脏病、高血压、高脂血症、糖尿病）评分规定，动脉高血压、高脂血症、糖尿病和慢性肾脏病的存在各计 1 分。将 CHLD 评分纳入 Cox 比例模型后，它仍然是 MACE 发生的唯一独立预测因子（每增加 1 分的单位 HR 为 3.46；95%CI 2.06-5.82，p<0.0001）。以 CHLD 评分形式评估传统危险因素的联合评估可能是无肺动脉高压 SSc 患者长期预后的可靠预测因子。
