系统性硬化症和间质性肺疾病患者的心脏功能障碍与5年死亡率：一项斑点追踪超声心动图研究
Cardiac Dysfunction and 5-Year Mortality in Patients With Systemic Sclerosis and Interstitial Lung Disease: A Speckle-Tracking Echocardiography Study.
作者信息
Demirci Murat, Özdemir Burcu, Zengin Gülçin, Oğuz Mustafa, Sünbül Murat, Sayar Nurten
机构信息
Department of Cardiology, Marmara University, Pendik Training and Research Hospital, Istanbul, Turkey.
Department of Radiology, Marmara University, Pendik Training and Research Hospital, Istanbul, Turkey.
出版信息
J Clin Ultrasound. 2025 May 29. doi: 10.1002/jcu.24094.
BACKGROUND/AIMS: Systemic sclerosis (SSc) is a chronic autoimmune disorder characterized by fibrosis, vascular abnormalities, and immune system activation, often leading to significant cardiac involvement and high mortality. Interstitial lung disease (ILD) is a common complication in SSc, potentially exacerbating cardiac dysfunction. This study aimed to evaluate cardiac function using speckle-tracking echocardiography (STE) and determine the impact of ILD on 5-year mortality in SSc patients.
METHODS
In this prospective cohort study, 68 SSc patients were divided into two groups based on the presence of ILD, assessed by thoracic computed tomography (CT): ILD group (n = 32) and non-ILD group (n = 36). Both conventional echocardiography and STE were performed to assess cardiac function, with left ventricular global longitudinal strain (LV GLS) and right ventricular global longitudinal strain (RV GLS) as primary measures. Five-year mortality data were collected and analyzed.
RESULTS
The ILD group exhibited significantly lower LV GLS (-15.62% ± 2.74%) and RV GLS (-16.46% ± 4.38%) compared to the non-ILD group (-18.01% ± 2.73%, p = 0.001 and -20.22% ± 4.30%, p = 0.001, respectively). Atrial strain parameters, including both left and right atrial reservoir and contractile strain, were significantly impaired in the ILD group. Five-year all-cause mortality was significantly higher in the ILD group (46.87%) compared to the non-ILD group (19.44%, p = 0.016). Multivariate logistic regression identified age (OR = 1.120, 95% CI: 1.022-1.226, p = 0.015) and RV GLS (OR = 0.686, 95% CI: 0.550-0.856, p = 0.001) as independent predictors of mortality. RV GLS predicted 5-year mortality with a sensitivity of 86.4% and a specificity of 80.4% at a cut-off value of -17.3%.
CONCLUSION
SSc patients with ILD exhibit significant cardiac dysfunction and higher 5-year mortality compared to those without ILD.
背景/目的：系统性硬化症（SSc）是一种慢性自身免疫性疾病，其特征为纤维化、血管异常和免疫系统激活，常导致严重的心脏受累及高死亡率。间质性肺疾病（ILD）是SSc的常见并发症，可能会加重心脏功能障碍。本研究旨在使用斑点追踪超声心动图（STE）评估心脏功能，并确定ILD对SSc患者5年死亡率的影响。
方法
在这项前瞻性队列研究中，68例SSc患者根据胸部计算机断层扫描（CT）评估的ILD情况分为两组：ILD组（n = 32）和非ILD组（n = 36）。同时进行传统超声心动图和STE以评估心脏功能，主要测量指标为左心室整体纵向应变（LV GLS）和右心室整体纵向应变（RV GLS）。收集并分析5年死亡率数据。
结果
与非ILD组（分别为-18.01%±2.73%，p = 0.001和-20.22%±4.30%，p = 0.001）相比，ILD组的LV GLS（-15.62%±2.74%）和RV GLS（-16.46%±4.38%）显著降低。ILD组的心房应变参数，包括左、右心房储备和收缩应变，均显著受损。ILD组的5年全因死亡率（46.87%）显著高于非ILD组（19.44%，p = 0.016）。多因素逻辑回归分析确定年龄（OR = 1.120，95%CI：1.022 - 1.226，p = 0.015）和RV GLS（OR = 0.686，95%CI：0.550 - 0.856，p = 0.001）为死亡率的独立预测因素。RV GLS预测5年死亡率时，在截断值为-17.3%时，敏感性为86.4%，特异性为80.4%。
结论
与无ILD的SSc患者相比，有ILD的SSc患者表现出明显的心脏功能障碍和更高的5年死亡率。
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