Cardiovascular outcomes in systemic sclerosis-induced pulmonary hypertension

SESSION TITLE: Severity and Outcomes of Disease in Pulmonary Vascular Disease SESSION TYPE: Original Investigations PRESENTED ON: 10/10/2023 01:45 pm - 02:45 pm PURPOSE: Systemic sclerosis (SSc) is a complex autoimmune rheumatic disease characterized by immune-mediated activation of both innate and adaptive immunity. Pulmonary involvement, specifically pulmonary arterial hypertension, is the leading cause of death in SSc. Cardiac involvement, although mostly asymptomatic, has been linked to poor prognosis and increased mortality. The purpose of the study is to investigate the association of pulmonary hypertension (PH) as a risk factor for developing cardiovascular complications in individuals with SSc. METHODS: National Inpatient Sample Database was used to procure individuals with SSc and patients were divided into two groups based on the presence of PH. Baseline demographics and comorbidities were collected using ICD-10 codes. Patients with missing data, age under 18, or those diagnosed with PH due to another etiology were excluded. Greedy propensity matching using R was performed to match patients with and without PH on age, race, gender, and 15 other comorbidities. Univariate analysis pre- and post-match were performed. Binary logistic regression was performed post-match to assess whether PH was an independent risk factor for cardiovascular complications. A p-value of <0.05 was considered statistically significant. RESULTS: Out of 17,675 patients included in the study, 1,294 had PH. PH patients were older and had higher prevalence of baseline comorbidities. On univariate analysis, PH patients had significantly higher acute heart failure (29.8% vs 17.9%), tachyarrhythmias (27.7% vs 18.5%), conduction disease (6.9% vs 4.2%), aortic valve disease (5.9% vs 3.5%) and tricuspid valve disease (1.9% vs 0.7%). After matching, binary logistic regression analysis showed PH patients having higher conduction disease (OR: 1.73 [1.22-2.45]; p<0.01) and tachyarrhythmias (OR: 1.24 [1.04-1.48]; p=0.02). CONCLUSIONS: PH in SSc patients was associated with higher prevalence of conduction disorders and tachyarrhythmias. The probable etiology of these findings can be attributed to microvascular dysfunction and myocardial fibrosis commonly associated with SSc. CLINICAL IMPLICATIONS: Regular cardiovascular monitoring with a lower threshold for cardiac workup is recommended for SSc patients, particularly after the emergence of PH. Large-scale trials with specific focus on SSc patients with PH are required to formulate appropriate preventive and management guidelines. DISCLOSURES: No relevant relationships by Saif Abu-Baker No relevant relationships by Michel Chalhoub No relevant relationships by KHALIL EL GHARIB No disclosure on file for Suzanne El-Sayegh No relevant relationships by Radu Grovu No relevant relationships by Georges Khattar No relevant relationships by Omar Mourad No relevant relationships by Ahmad Mustafa No relevant relationships by Waleed Sadiq No relevant relationships by Saud Bin Abdul Sattar No relevant relationships by Fasih Sami Siddiqui No disclosure on file for Chapman Wei