Abstract
BackgroundCardiovascular diseases are common cause of morbidity and mortality in patients with systemic connective tissue diseases (SCTD) due to accelerated atherosclerosis which couldn't be explained by traditional risk factors (CVDRF).HypothesisWe hypothesized that recently developed score predicting probability of heart failure with preserved ejection fraction (H2FPEF), as well as a measure of right ventricular‐pulmonary vasculature coupling [tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) ratio], are predictive of atherosclerosis in SCTD.Methods203 patients (178 females) diagnosed with SCTD underwent standard and stress‐echocardiography (SE) with TAPSE/PASP and left ventricular (LV) diastolic filling pressure (E/e') measurements, carotid ultrasound and computed tomographic coronary angiography. Patients who were SE positive for ischemia underwent coronary angiography (34/203). The H2FPEF score was calculated according to age, body mass index, presence of atrial fibrillation, ≥2 antihypertensives, E/e' and PASP.ResultsMean LV ejection fraction was 66.3 ± 7.1%. Atherosclerosis was present in 150/203 patients according to: 1) intima‐media thickness>0.9 mm; and 2) Agatstone score > 300 or Syntax score ≥ 1. On binary logistic regression analysis, including CVDRF prevalence, echocardiographic parameters and H2FPEF score, only H2FPEF score remained significant for the prediction of atherosclerosis presence (χ2 = 19.3, HR 2.6, CI 1.5‐4.3, p < 0.001), and resting TAPSE/PASP for the prediction of a SE positive for ischemia (χ2 = 10.4, HR 0.01, CI = 0.01‐0.22, p = 0.004). On ROC analysis, the optimal threshold value for identifying patients with atherosclerosis was a H2FPEF score ≥2 (Sn 60.4%, Sp 69.4%, area 0.67, SE = 0.05, p < 0.001).ConclusionsH2FPEF score and resting TAPSE/PASP demonstrated clinical value for an atherosclerosis diagnosis in patients diagnosed with SCTD.
Highlights
Cardiovascular diseases (CVD) are the most common cause of morbidity and mortality in patients with systemic connective tissue diseases (SCTD) generally due to premature atherosclerosis.[1]
The purpose of the present investigation was to examine the predictive value of H2FPEF score and tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) ratio, as a measure of RV-PV coupling, for atherosclerosis presence in patients diagnosed with SCTD
A high predictive value for atherosclerosis presence and development of myocardial ischemia in patients diagnosed with SCTD was demonstrated for rest and peak TAPSE/PASP, and they both significantly correlated with H2FPEF score
Summary
Cardiovascular diseases (CVD) are the most common cause of morbidity and mortality in patients with systemic connective tissue diseases (SCTD) generally due to premature atherosclerosis.[1] Current recommendations suggest assessment of general CVD risk factors (CVDRFs) in these patients, as part of risk prediction algorithms such as Systematic Coronary Risk Evaluation (SCORE)[2] and Framingham[3] in order to calculate a 10-year risk of CVD events. The purpose of the present investigation was to examine the predictive value of H2FPEF score and tricuspid annular plane systolic excursion (TAPSE)/PASP ratio, as a measure of RV-PV coupling, for atherosclerosis presence in patients diagnosed with SCTD
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