Prevalence and Prognostic Significance of Heart Failure With Preserved Ejection Fraction in Systemic Sclerosis

Abstract

Aim: Heart failure with preserved ejection fraction (HFpEF) is a clinically relevant complication of systemic sclerosis (SSc). We aimed to examine the prevalence, correlates and prognostic significance of HFpEF in an SSc population. Materials & methods: HFpEF was defined by the presence of exertional dyspnoea, abnormal cardiac structure (left ventricular hypertrophy or left atrial enlargement) and NT-proBN (>125 pg/ml). Results: Of the 155 studied patients, 27% had HFpEF criteria. These patients were older, had more cardiovascular risk factors, and were more likely to have atrial fibrillation or interstitial lung disease. Conclusion: Over a median follow-up of 9 years, SSc patients with HFpEF had a 3.4-fold increased risk of dying (HR: 3.37, 95% CI: 1.21–9.31), although this association has lost statistical significance after adjusting for age. On the contrary, NT-proBNP was an independent predictor of a worse prognosis.

Lay abstract

Heart failure with preserved ejection fraction (HFpEF) is the most common heart failure type worldwide and can be a complication of the rare disease of systemic sclerosis (SSc). In this study, we examined the proportion of SSc patients who presented the diagnostic criteria of HFpEF. Of the 155 studied patients with SSc, one out of four had those HFpEF criteria. These patients were older, had more cardiovascular risk factors, and were more likely to have arrhythmias or lung disease. Over 9 years, SSc patients with HFpEF had a 3.4-fold increased risk of dying, although this association was lost after adjusting for age. NT-proBNP, a heart failure plasma biomarker, was an independent predictor of worse prognosis.

Keywords:

• heart failure
• heart failure with preserved ejection fraction
• systemic sclerosis

Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at: www.tandfonline.com/doi/full/10.2217/fca-2020-0238

Author contributions

M Santos and I Almeida contributed to the conception of the study. MF Oliveira and AL Rei contributed to data collection. M Santos and MF Oliveira participated in statistical analysis. M Santos, MF Oliveira, AL Rei and MI Oliveira drafted the manuscript. All authors critically revised the manuscript, gave final approval and agreed to be accountable for all aspects of the work.

Financial & competing interests disclosure

This project was supported by Fundação para a Ciência e Tecnologia grant (PTDC/MEC-CAR/30011/2017), co-financed by the FEDER – Fundo Europeu de Desenvolvimento Regional under the new Partnership Agreement PT2020 within the project POCI-01-0145-FEDER-030011. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.