Increased Prevalence of Moderate to Severe Mitral and Aortic Valve Dysfunction in Systemic Sclerosis: A Case-control Study

Javier Narváez; Judit LLuch; Alejandro Ruiz-Majoral; Miguel Angel Sánchez-Corral; Eduard Claver; Joan M Nolla

doi:10.3899/jrheum.201025

Increased Prevalence of Moderate to Severe Mitral and Aortic Valve Dysfunction in Systemic Sclerosis: A Case-control Study

J Rheumatol. 2021 Mar;48(3):394-401. doi: 10.3899/jrheum.201025. Epub 2020 Nov 15.

Authors

Javier Narváez¹, Judit LLuch², Alejandro Ruiz-Majoral³, Miguel Angel Sánchez-Corral³, Eduard Claver³, Joan M Nolla²

Affiliations

¹ J. Narváez, MD, PhD, J. LLuch, MD, J.M. Nolla, MD, PhD, Department of Rheumatology, Hospital Universitario de Bellvitge; fjnarvaez@bellvitgehospital.cat.
² J. Narváez, MD, PhD, J. LLuch, MD, J.M. Nolla, MD, PhD, Department of Rheumatology, Hospital Universitario de Bellvitge.
³ A. Ruiz-Majoral, MD, M.A. Sánchez-Corral, MD, E. Claver, MD, Department of Cardiology, Hospital Universitario de Bellvitge, Barcelona, Spain.

PMID: 33191275
DOI: 10.3899/jrheum.201025

Abstract

Objective: To investigate the prevalence, severity, and associated clinical factors of mitral and aortic valvular involvement in patients with systemic sclerosis (SSc).

Methods: Our case-control study included 172 patients with SSc and 172 non-SSc adults without known cardiac disease matched by age, sex, and prevalence of cardiovascular (CV) risk factors. The screening of mitral and aortic valvular involvement was performed by transthoracic Doppler echocardiogram. The prevalence of aortic stenosis (AS) was also compared with that reported in a population-based study performed in our community during the same period.

Results: Patients with SSc showed an almost 5-fold increased prevalence of moderate to severe mitroaortic valve dysfunction compared to non-SSc controls (OR 4.60, 95% CI 1.51-13.98; P = 0.003). The most common lesion was mitral regurgitation (MR), which was observed in 5.2% of patients, followed by AS in 3.5%, and aortic regurgitation (AR) in 1.7%. Analyzing the different types of valvular lesion separately, we observed a significantly higher frequency of MR compared to controls (OR 4.69, 95% CI 1.12-22.04; P = 0.032), as well as a higher frequency of AS in the 65-75 (OR 7.51, 95% CI 1.22-46.23, P = 0.01) and 76-85 age groups (OR 3.53, 95% CI 1.03-12.22, P = 0.043) when compared to the general population in our community.

Conclusion: We found an increased prevalence of moderate to severe MR and AS in SSc compared to age-matched non-SSc controls with similar CV comorbidities. While results from this study do not allow for establishing a direct causal relationship, they strongly support the contribution of SSc-specific factors in the development of these complications.

Keywords: aortic valve; mitral valve; systemic sclerosis; valvular heart disease.

MeSH terms

Adult
Aortic Valve / diagnostic imaging
Aortic Valve Insufficiency* / diagnostic imaging
Aortic Valve Insufficiency* / epidemiology
Aortic Valve Insufficiency* / etiology
Case-Control Studies
Humans
Prevalence
Scleroderma, Systemic* / complications
Scleroderma, Systemic* / diagnostic imaging
Scleroderma, Systemic* / epidemiology