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Article

Higher Ventricular-Arterial Coupling Derived from Three-Dimensional Echocardiography Is Associated with a Worse Clinical Outcome in Systemic Sclerosis

1
Department of Cardiac, Thoracic, Vascular Sciences and Public Health, 35128 Padova, Italy
2
Department of Medicine, Padova University Hospital, 35128 Padova, Italy
3
Clinical Cardiology, AOU Cagliari, Department of Medical Science and Public Health, University of Cagliari, 09042 Cagliari, Italy
*
Author to whom correspondence should be addressed.
These two authors contributed equally to the article.
Academic Editors: Francesco Salton, Barbara Ruaro and Paola Confalonieri
Pharmaceuticals 2021, 14(7), 646; https://doi.org/10.3390/ph14070646
Received: 2 March 2021 / Revised: 1 July 2021 / Accepted: 2 July 2021 / Published: 5 July 2021
Primary myocardial involvement is common in systemic sclerosis (SSc). Ventricular-arterial coupling (VAC) reflecting the interplay between ventricular performance and arterial load, is a key determinant of cardiovascular (CV) performance. We aimed to investigate VAC, VAC-derived indices, and the potential association between altered VAC and survival free from death/hospitalization for major adverse CV events (MACE) in scleroderma. Only SSc patients without any anamnestic and echocardiographic evidence of primary myocardial involvement who underwent three-dimensional echocardiography (3DE) were included in this cross-sectional study and compared with healthy matched controls. 3DE was used for noninvasive measurements of end-systolic elastance (Ees), arterial elastance (Ea), VAC (Ea/Ees) and end-diastolic elastance (Eed); the occurrence of death/hospitalization for MACE was recorded during follow-up. Sixty-five SSc patients (54 female; aged 56 ± 14 years) were included. Ees (p = 0.04), Ea (p = 0.04) and Eed (p = 0.01) were higher in patients vs. controls. Thus, VAC was similar in both groups. Ees was lower and VAC was higher in patients with diffuse cutaneous form (dcSSc) vs. patients with limited form (lcSSc) (p = 0.001 and p = 0.02, respectively). Over a median follow-up of 4 years, four patients died for heart failure and 34 were hospitalized for CV events. In patients with VAC > 0.63 the risk of MACE was higher (HR 2.5; 95% CI 1.13–5.7; p = 0.01) and survival free from death/hospitalization was lower (p = 0.005) than in those with VAC < 0.63. Our study suggests that VAC may be impaired in SSc patients without signs and symptoms of primary myocardial involvement. Moreover, VAC appears to have a prognostic role in SSc. View Full-Text
Keywords: heart failure; 3D-echocardiography; ventricular function; outcome; systemic sclerosis; ventricular-arterial coupling heart failure; 3D-echocardiography; ventricular function; outcome; systemic sclerosis; ventricular-arterial coupling
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MDPI and ACS Style

Tona, F.; Zanatta, E.; Montisci, R.; Muraru, D.; Beccegato, E.; De Zorzi, E.; Benvenuti, F.; Civieri, G.; Cozzi, F.; Iliceto, S.; Doria, A. Higher Ventricular-Arterial Coupling Derived from Three-Dimensional Echocardiography Is Associated with a Worse Clinical Outcome in Systemic Sclerosis. Pharmaceuticals 2021, 14, 646. https://doi.org/10.3390/ph14070646

AMA Style

Tona F, Zanatta E, Montisci R, Muraru D, Beccegato E, De Zorzi E, Benvenuti F, Civieri G, Cozzi F, Iliceto S, Doria A. Higher Ventricular-Arterial Coupling Derived from Three-Dimensional Echocardiography Is Associated with a Worse Clinical Outcome in Systemic Sclerosis. Pharmaceuticals. 2021; 14(7):646. https://doi.org/10.3390/ph14070646

Chicago/Turabian Style

Tona, Francesco, Elisabetta Zanatta, Roberta Montisci, Denisa Muraru, Elena Beccegato, Elena De Zorzi, Francesco Benvenuti, Giovanni Civieri, Franco Cozzi, Sabino Iliceto, and Andrea Doria. 2021. "Higher Ventricular-Arterial Coupling Derived from Three-Dimensional Echocardiography Is Associated with a Worse Clinical Outcome in Systemic Sclerosis" Pharmaceuticals 14, no. 7: 646. https://doi.org/10.3390/ph14070646

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