{
  "abstract": "Introduction Cardiac involvement significantly impacts prognosis in systemic sclerosis (SSc), highlighting the need for early risk stratification. Gastrointestinal (GI) symptoms are common and often manifest early. Emerging data suggest a link between GI and cardiac manifestations, possibly through shared mechanisms like dysautonomia and immune-mediated damage to mesodermally derived neurons. This study investigates the overall association between GI and cardiac involvement in early SSc and evaluates whether baseline GI symptoms predict future cardiac manifestations.Material and Methods We analyzed data from 459 patients with early SSc enrolled in the multicenter prospective GENISOS cohort. GI and cardiac manifestations were comprehensively evaluated both at baseline and throughout follow-up. GI involvement was defined as the presence of one or more of the following symptoms: dysphagia, peptic ulcer, bloating, diarrhea, malabsorption, constipation, or pseudo-obstruction. To assess whether any of these early GI symptoms could predict the later development of cardiac complications—specifically conduction abnormalities or systolic dysfunction—we applied Cox and multivariable logistic regression models, adjusting for key confounders such as age, sex, race, and disease duration.Results At baseline, 59% of patients had GI involvement. During follow-up, 26% of patients developed cardiac complications, mainly conduction defects (24%) and less frequently systolic dysfunction (5%). Cox regression was applied to identify baseline GI symptoms in SSc patients that predict cardiac complications. Interestingly, malabsorption and bloating emerged as the strongest predictors of subsequent cardiac complication with malabsorption in particular conferring the highest risk [HR 10.6 (95% CI: 3.0–37.4)], after adjusting for potential confounders (Tab. 1). A significant association was found between GI manifestations and cardiac involvement, with bloating showing the strongest association after adjustment in the multivariable model (OR 4.0, 95% CI 2.2–7.3) (Tab. 2). We then examined the strength of the association between individual GI symptoms and the two cardiac complications. Notably, upper GI symptoms like dysphagia (OR 1.98; 95% CI: 1.2–3.3) and peptic ulcers (OR 3.10; 95% CI: 1.6-5.9) were specifically associated with conduction defects, while malabsorption was strongly associated with systolic dysfunction (OR 5.20; 95% CI: 1.9–13.9). These associations remained robust even after adjustment for potential confounders.Conclusions Upper GI dysfunction was associated specifically with conduction defects, suggesting that autonomic dysfunction is a contributory factor. In contrast, lower GI involvement, particularly malabsorption, was linked to systolic dysfunction in SSc patients, potentially indicating a distinct biological mechanism. These findings may support integrating early GI symptoms into cardiac risk stratification and provide a foundation for future translational studies.",
  "authors": [
    {
      "affiliations": [
        "La Sapienza University of Rome, Rheumatology Unit, Department of Medical and Cardiovascular Sciences, Rome, Italy"
      ],
      "name": "Francesca Romana Di Ciommo"
    },
    {
      "affiliations": [
        "Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA"
      ],
      "name": "Subhash Kulkarni"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, UTHealth Houston, Houston, USA"
      ],
      "name": "Aidan Strother"
    },
    {
      "affiliations": [
        "Division of Rheumatology, UTHealth Houston, Houston, USA"
      ],
      "name": "Ashish Balar"
    },
    {
      "affiliations": [
        "Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Center for Musculoskeletal Re, Manchester, United Kingdom",
        "Department of Rheumatology, Northern Care Alliance NHS Foundation Trust, Salford Care Organisation, Salford, United Kingdom",
        "NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Michael Hughes"
    },
    {
      "affiliations": [
        "Division of Rheumatology, UTHealth Houston, Houston, USA"
      ],
      "name": "Brian Skaug"
    },
    {
      "affiliations": [
        "Division of Rheumatology, UTHealth Houston, Houston, USA"
      ],
      "name": "Maureen Mayes"
    },
    {
      "affiliations": [
        "Division of Rheumatology, UTHealth Houston, Houston, USA"
      ],
      "name": "Shervin Assassi"
    },
    {
      "affiliations": [
        "Division of Rheumatology, UTHealth Houston, Houston, USA"
      ],
      "name": "Ali Ayla Yagiz"
    },
    {
      "affiliations": [
        "Division of Rheumatology, UTHealth Houston, Houston, USA"
      ],
      "name": "Zsuzsanna Mcmahan"
    }
  ],
  "title": "P.176 The gut-heart axis in systemic sclerosis: evidence from the genisos cohort",
  "uid": "11260d93-ea67-58f1-a139-6d0efa09098f"
}