Prevalence and prognostic significance of heart failure with preserved ejection fraction in systemic sclerosis

Aim: Heart failure with preserved ejection fraction (HFpEF) is a clinically relevant complication of systemic sclerosis (SSc). We aimed to examine the prevalence, correlates and prognostic significance of HFpEF in an SSc population. Materials & methods: HFpEF was defined by the presence of exertional dyspnoea, abnormal cardiac structure (left ventricular hypertrophy or left atrial enlargement) and NT-proBN (>125 pg/ml). Results: Of the 155 studied patients, 27% had HFpEF criteria. These patients were older, had more cardiovascular risk factors, and were more likely to have atrial fibrillation or interstitial lung disease. Conclusion: Over a median follow-up of 9 years, SSc patients with HFpEF had a 3.4-fold increased risk of dying (HR: 3.37, 95% CI: 1.21-9.31), although this association has lost statistical significance after adjusting for age. On the contrary, NT-proBNP was an independent predictor of a worse prognosis. Lay abstract Heart failure with preserved ejection fraction (HFpEF) is the most common heart failure type worldwide and can be a complication of the rare disease of systemic sclerosis (SSc). In this study, we examined the proportion of SSc patients who presented the diagnostic criteria of HFpEF. Of the 155 studied patients with SSc, one out of four had those HFpEF criteria. These patients were older, had more cardiovascular risk factors, and were more likely to have arrhythmias or lung disease. Over 9 years, SSc patients with HFpEF had a 3.4-fold increased risk of dying, although this association was lost after adjusting for age. NT-proBNP, a heart failure plasma biomarker, was an independent predictor of worse prognosis.