Sex-specific difference in cardiac function in patients with systemic sclerosis: association with cardiovascular outcomes
RMD Open, vol. 9, pp. e003380
Abstract
Background Cardiovascular involvement is one of the leading causes of mortality in systemic sclerosis (SSc) and is reported to be higher in men as compared with women. However, the cause of this difference is largely unknown. The objective of this study was to assess sex differences in echocardiographic characteristics, including left ventricular global longitudinal strain (LV GLS), as a potential explanation of sex differences in outcomes. Methods A total of 746 patients with SSc from four centres, including 628 (84%, 54±13 years) women and 118 (16%, 55±15 years) men, were evaluated with standard and advanced echocardiographic examinations. The independent association of the echocardiographic parameters with the combined endpoint of cardiovascular events-hospitalisation/death was evaluated. Results Men and women with SSc showed significant differences in disease characteristics and cardiac function. After adjusting for the most important clinical characteristics, while LV ejection fraction and diastolic function were not significantly different anymore, men still presented with more impaired LV GLS as compared with women (−19% (IQR −20% to −17%) vs −21% (IQR: −22% to −19%), p<0.001). After a median follow-up of 48 months (IQR: 26–80), the combined endpoint occurred in 182 patients. Men with SSc experienced higher cumulative rates of cardiovascular events-hospitalisation/mortality (χ2=8.648; Log-rank=0.003), and sex differences were maintained after adjusting for clinical confounders, but neutralised when matching the groups for LV GLS. Conclusion In patients with SSc, male sex is associated with worse cardiovascular outcomes even after adjusting for important clinical characteristics. LV GLS was more impaired in men as compared with women and potentially explains the sex difference in cardiovascular outcomes.
Authors 13
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Leiden University Medical Center · Tbilisi State Medical University
Affiliation as printed
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Internal Medicine, Tbilisi State Medical University, Tbilisi, Georgia
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Leiden University Medical Center
Affiliation as printed
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Department of Cardiology, Ospedale Nuovo San Giovanni Battista, Foligno, Umbria, Italy
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Leiden University Medical Center
Affiliation as printed
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
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Affiliation as printed
Department of Rheumatology, Oslo University Hospital, Oslo, Norway
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Affiliation as printed
Department of Rheumatology, Oslo University Hospital, Oslo, Norway
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Institutul de Urgenţă pentru Boli Cardiovasculare "Prof.Dr. C.C. Iliescu"
Affiliation as printed
Department of Cardiology, Emergency Institute for Cardiovascular Diseases Prof C C Iliescu, Bucuresti, Romania
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Institutul de Urgenţă pentru Boli Cardiovasculare "Prof.Dr. C.C. Iliescu"
Affiliation as printed
Department of Cardiology, Emergency Institute for Cardiovascular Diseases Prof C C Iliescu, Bucuresti, Romania
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Carol Davila University of Medicine and Pharmacy
Affiliation as printed
Department of Internal Medicine Rheumatology, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
Internal Medicine and Rheumatology, Santa Maria Clinical Hospital, Bucharest, Romania
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Affiliation as printed
Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
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Affiliation as printed
Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
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University of Turku · Leiden University Medical Center
Affiliation as printed
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Department of Cardiology, Turku University Finland, Turku, Finland
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Leiden University Medical Center
Affiliation as printed
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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