Contribution of left ventricular diastolic dysfunction to survival and breathlessness in systemic sclerosis interstitial lung disease.

OBJECTIVE:To explore the impact of left ventricular diastolic dysfunction (LVDD) in systemic-sclerosis (SSc)-associated interstitial lung disease (ILD), and to investigate SSc-specific associations and clinical correlates of LVDD. METHODS:One-hundred and two Australian Scleroderma Cohort Study participants with definite SSc and radiographic ILD were included. Diastolic function was classified as normal, indeterminate, or abnormal according to 2016 ASE/EACVI guidelines for assessment of left ventricular diastolic function. Associations between clinical features and patient- and physician-reported dyspnoea were evaluated using logistic regression. Survival analyses were performed using Kaplan-Meier survival estimates and Cox regression modelling. RESULTS:LVDD was identified in 26% of participants, while 19% had indeterminate and 55% had normal diastolic function. Those with ILD and LVDD had increased mortality (HR 2.4, 95% CI 1.0-5.7, p=0.05). After adjusting for age and sex, those with ILD-LVDD were more likely to have severe dyspnoea on the Borg Dyspnoea Scale (OR 2.6, 95% CI 1.0-6.6, p=0.05) and numerically more likely to record WHO Function Class II or higher dyspnoea (OR 4.0, 95% CI 0.8-19.3, p=0.08). Older age (95% CI 1.0-6.4, p=0.05), hypertension (OR 5.0, 95% CI 1.8-13.8, p<0.01) and ischaemic heart disease (OR 4.8, 95% CI 1.5-15.7, p<0.01) were all associated with LVDD, as was proximal muscle atrophy (OR 5.0, 95% CI 1.9-13.6, p<0.01) and multimorbidity (Charlson Comorbidity Index scores ≥4; OR 3.0, 95% CI 1.1-8.7, p=0.04). CONCLUSION:LVDD in SSc-ILD is more strongly associated with traditional LVDD risk factors than SSc-specific factors. LVDD is associated with worse dyspnoea and survival in those with SSc-ILD.