Cardiovascular outcome in systemic sclerosis

Abstract

Objectives Cardiovascular involvement is recognized as a poor prognostic factor in systemic sclerosis (SSc). The aim of this study was to evaluate the usefulness of nailfold video-capillaroscopy (NVC), brain natriuretic peptide (BNP) blood level and exercise echocardiography to predict the occurrence of cardiovascular events in SSc.

Methods We prospectively enrolled 65 patients with SSc (age 54 ± 14 years, 30% female) followed in CHU Sart-Tilman, Liège, Belgium. All patients underwent graded semi-supine exercise echocardiography. Both baseline resting pulmonary hypertension (PH) and PH during follow-up (FUPH) were defi ned as systolic pulmonary arterial pressure (sPAP) > 35 mmHg, and exercise-induced PH (EIPH) as sPAP > 50 mmHg during exercise.

Results EIPH was present in 21 patients. During FU (27 ± 18 months), 13 patients developed FUPH and 9 presented cardiovascular complications. Patients with cardiovascular events were signifi cantly older (63 ± 14 vs 52 ± 13 years; P = 0.03), presented more frequently NVC grade > 2 (89 vs 43%; P = 0.009), had higher resting and exercise sPAP (30 ± 6 vs 24 ± 6; P = 0.007 and 57 ± 13 vs 44 ± 13 vs mmHg; P = 0.01, respectively), and higher BNP blood level (112 ± 106 vs 26 ± 19 pg/ml; P = 0.0001). After adjustment for age and gender, NVC grade > 2 (ß = 2.4 ± 1.1; P = 0.03), EIPH (ß = 2.30 ± 1.13; P = 0.04), FUPH (ß = 0.24 ± 0.09; P = 0.01 and ß = 3.52 ± 1.16; P = 0.002, respectively;) and BNP (ß = 0.08 ± 0.04; P = 0.02) were independent predictors of CV events. Beyond age, an incremental value of EIPH, BNP and NVC grade > 2 was predictive of cardiovascular events (P < 0.001).

Conclusion Cardiovascular complications are not rare in SSc (18%). NVC, BNP blood level assessment and exercise echocardiography could be useful tools to identify patients at risk of SSc.

Key Words:

• Systemic sclerosis
• echocardiography
• pulmonary hypertension
• exercise
• nailfold videocapillaroscopy
• cardio-vascular diseases
• brain
• natriuretic peptide