Cardiac Dysfunction and 5-Year Mortality in Patients With Systemic Sclerosis and Interstitial Lung Disease: A Speckle-Tracking Echocardiography Study.

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.