Sex-specific difference in cardiac function in patients with systemic sclerosis: association with cardiovascular outcomes
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 echocardiogra...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-10-01
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| Series: | RMD Open |
| Online Access: | https://rmdopen.bmj.com/content/9/4/e003380.full |
| _version_ | 1797366711209426944 |
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| author | Oliver Distler Jeroen J Bax Jeska De Vries-Bouwstra Anna-Maria Hoffmann-Vold Laura Groseanu Nina Ajmone Marsan Federico Fortuni Nina Marijn van Leeuwen Tea Gegenava Anders H Tennoe Ruxandra Jurcut Adrian Giuca Felix Tanner |
| author_facet | Oliver Distler Jeroen J Bax Jeska De Vries-Bouwstra Anna-Maria Hoffmann-Vold Laura Groseanu Nina Ajmone Marsan Federico Fortuni Nina Marijn van Leeuwen Tea Gegenava Anders H Tennoe Ruxandra Jurcut Adrian Giuca Felix Tanner |
| author_sort | Oliver Distler |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-08T17:08:13Z |
| format | Article |
| id | doaj.art-2224fb66ffa44d3985938301a0af5600 |
| institution | Directory Open Access Journal |
| issn | 2056-5933 |
| language | English |
| last_indexed | 2024-03-08T17:08:13Z |
| publishDate | 2023-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | RMD Open |
| spelling | doaj.art-2224fb66ffa44d3985938301a0af56002024-01-04T04:15:08ZengBMJ Publishing GroupRMD Open2056-59332023-10-019410.1136/rmdopen-2023-003380Sex-specific difference in cardiac function in patients with systemic sclerosis: association with cardiovascular outcomesOliver Distler0Jeroen J Bax1Jeska De Vries-Bouwstra2Anna-Maria Hoffmann-Vold3Laura Groseanu4Nina Ajmone Marsan5Federico Fortuni6Nina Marijn van Leeuwen7Tea Gegenava8Anders H Tennoe9Ruxandra Jurcut10Adrian Giuca11Felix Tanner12Rheumatology, University Hospital Zurich, University of Zurich, Zurich, SwitzerlandDepartment of Cardiology, Leiden University Medical Center, Leiden, The NetherlandsDepartment of Rheumatology, Leiden University Medical Center, Leiden, The NetherlandsDepartment of Rheumatology, Oslo University Hospital, Oslo, NorwayDepartment of Internal Medicine Rheumatology, University of Medicine and Pharmacy Carol Davila, Bucharest, RomaniaDepartment of Cardiology, Leiden University Medical Center, Leiden, The NetherlandsDepartment of Cardiology, Leiden University Medical Center, Leiden, The NetherlandsDepartment of Rheumatology, Leiden University Medical Center, Leiden, The NetherlandsDepartment of Cardiology, Leiden University Medical Center, Leiden, The NetherlandsDepartment of Rheumatology, Oslo University Hospital, Oslo, NorwayDepartment of Cardiology, Emergency Institute for Cardiovascular Diseases Prof C C Iliescu, Bucuresti, RomaniaDepartment of Cardiology, Emergency Institute for Cardiovascular Diseases Prof C C Iliescu, Bucuresti, RomaniaDepartment of Cardiology, University Hospital Zurich, Zurich, SwitzerlandBackground 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.https://rmdopen.bmj.com/content/9/4/e003380.full |
| spellingShingle | Oliver Distler Jeroen J Bax Jeska De Vries-Bouwstra Anna-Maria Hoffmann-Vold Laura Groseanu Nina Ajmone Marsan Federico Fortuni Nina Marijn van Leeuwen Tea Gegenava Anders H Tennoe Ruxandra Jurcut Adrian Giuca Felix Tanner Sex-specific difference in cardiac function in patients with systemic sclerosis: association with cardiovascular outcomes RMD Open |
| title | Sex-specific difference in cardiac function in patients with systemic sclerosis: association with cardiovascular outcomes |
| title_full | Sex-specific difference in cardiac function in patients with systemic sclerosis: association with cardiovascular outcomes |
| title_fullStr | Sex-specific difference in cardiac function in patients with systemic sclerosis: association with cardiovascular outcomes |
| title_full_unstemmed | Sex-specific difference in cardiac function in patients with systemic sclerosis: association with cardiovascular outcomes |
| title_short | Sex-specific difference in cardiac function in patients with systemic sclerosis: association with cardiovascular outcomes |
| title_sort | sex specific difference in cardiac function in patients with systemic sclerosis association with cardiovascular outcomes |
| url | https://rmdopen.bmj.com/content/9/4/e003380.full |
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