Bawaskar Parag, Chhikara Sanya, Guo Yugene, Athwal Pal Satyajit Singh, Shenoy Chetan
Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA.
Eur Heart J Cardiovasc Imaging. 2025 May 30;26(6):1029-1038. doi: 10.1093/ehjci/jeaf086.
Systemic sclerosis (SSc) is a rare autoimmune disorder associated with a high risk of cardiovascular diseases. We aimed to determine the long-term prognostic value of left and right ventricular (LV and RV) systolic dysfunction in SSc patients with clinically suspected cardiac disease.
We conducted a retrospective cohort study of consecutive adults with SSc who had cardiovascular magnetic resonance (CMR) imaging for suspected cardiac disease. We assessed two CMR measures of LV and RV function, ejection fraction (EF), and feature tracking-derived global longitudinal strain (GLS) and investigated their associations with the long-term incidence of a composite endpoint of death or major adverse cardiac events (MACE). In 151 patients (median age 58 years, 81% women) who had CMR at a median of 3.6 years after diagnosis, the median LVEF was 58.0%, and the median LVGLS was -15.7%. The median RVEF was 57.0%, and the median RVGLS was -16.2%. Over a median follow-up of 4.7 years, 69 patients experienced the composite endpoint of death or MACE. LVGLS was independently associated with the composite endpoint [hazard ratio (HR) 1.08 per 1% worsening; 95% confidence interval (CI) 1.01-1.15; P = 0.018], while LVEF was not. Similarly, RVGLS was independently associated with the composite endpoint (HR 1.08 per 1% worsening; 95% CI 1.01-1.15; P = 0.017), while RVEF was not.
In patients with SSc and clinically suspected cardiac disease, worse LVGLS and RVGLS on CMR were independently associated with death or MACE, while LVEF and RVEF were not.
系统性硬化症（SSc）是一种罕见的自身免疫性疾病，与心血管疾病的高风险相关。我们旨在确定临床疑似心脏病的SSc患者左心室和右心室（LV和RV）收缩功能障碍的长期预后价值。
我们对连续的成年SSc患者进行了一项回顾性队列研究，这些患者因疑似心脏病接受了心血管磁共振（CMR）成像。我们评估了LV和RV功能的两种CMR测量指标，射血分数（EF）和特征追踪衍生的整体纵向应变（GLS），并研究了它们与死亡或主要不良心脏事件（MACE）复合终点的长期发生率之间的关联。在151例患者（中位年龄58岁，81%为女性）中，他们在诊断后中位3.6年时进行了CMR检查，中位左心室射血分数（LVEF）为58.0%，中位左心室整体纵向应变（LVGLS）为-15.7%。中位右心室射血分数（RVEF）为57.0%，中位右心室整体纵向应变（RVGLS）为-16.2%。在中位4.7年的随访中，69例患者经历了死亡或MACE复合终点。LVGLS与复合终点独立相关[每恶化1%的风险比（HR）为1.08；99%置信区间（CI）为1.01-1.15；P = 0.018]，而LVEF则不然。同样，RVGLS与复合终点独立相关（每恶化1%的HR为1.08；95%CI为1.01-1.15；P = 0.017），而RVEF则不然。
在患有SSc且临床疑似心脏病的患者中，CMR上较差的LVGLS和RVGLS与死亡或MACE独立相关，而LVEF和RVEF则不然。
