Pos1302 speckle-tracking global longitudinal strain as a predictor of clinical outcomes in systemic sclerosis patients

Background Primary cardiac involvement occurs in up to 40% of patients affected by systemic sclerosis (SSc), and although it may be asymptomatic is associated with negative outcomes. Speckle-tracking derived global longitudinal strain (GLS) has been proven to be a cost-effective tool in the detection of left ventricular (LV) and right ventricular (RV) dysfunction in patients with SSc and no overt cardiac disease [1] . Objectives The aim of this study was to assess whether GLS can predict clinical outcomes in patients with SSc. Methods We conducted a prospective observational study enrolling all consecutive patients referred to our Scleroderma Unit between June 2016 and January 2022. All patients had a definite diagnosis of SSc according to ACR/EULAR criteria and no overt cardiac disease, pulmonary arterial hypertension, or atrial fibrillation at the time of enrollment. For each patient, echocardiogram and GLS calculations were performed at baseline and at each follow-up. We also collected all data regarding clinical history, hospitalizations or adverse events and ECGs. Results 164 patients (148 female, 58±14 years) were enrolled. Overall, 19 (11.6%) patients died during a median follow-up of 3.2 years for mainly non-cardiovascular deaths (7.3%) while cardiovascular deaths were lower (3% non-sudden, 1.3% sudden). Left GLS at first visit was associated with all-cause death, with a 1% left GLS worsening associated with a 19% increased risk of death after adjusting for age, gender, and LVEF (adjusted HR 1.19; 95% CI 1.05-1.35; p=0.007). Similarly, right GLS at first visit was associated with all-cause death, with a 1% right GLS worsening associated with a 12% increased risk of death after adjusting for age, gender, and TAPSE (adjusted HR 1.12; 95% CI 1.03-1.21; p=0.005). Patients with a left GLS worse (i.e. higher) than -20% had a 3.5-fold increased risk of death when compared to patients with better left GLS (HR 3.55; 95% CI 1.28-9.88; p=0.015; Figure 1a). Similarly, patients with a right GLS worse than -20% had a 4.5-fold increased risk of death when compared to patients with better left GLS (HR 4.47; 95% CI 1.4-13.74; p=0.009; Figure 1b). Conclusion We demonstrated that GLS is associated with clinical outcomes in patients with SSc. GLS is a reproducible and cost-effective echocardiographic based method to assess SSc primary heart involvement and its progression, therefore allowing an earlier intervention in patients with worse prognosis. Reference [1]Guerra F, et al. Global longitudinal strain measured by speckle tracking identifies subclinical heart involvement in patients with systemic sclerosis. Eur J Prev Cardiol. 2018 Oct;25(15):1598-1606. Figure 1. Acknowledgements: NIL. Disclosure of Interests None Declared.