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DD risk factors and SSc disease characteristics were prospectively obtained, and the presence or absence of DD was determined using the most recent 2\u2010D echocardiogram. Logistic regression models examined associations between clinical risk factors and DD, and Cox proportional hazards models were used to assess survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>DD was present in 18.6% of participants. The majority of participants were female (84%) with a median age of 58.4\u2009years (interquartile range 48.8\u201368.1). Older age (odds ratio [OR] 1.12 [95% confidence interval (95% CI) 1.09\u20131.15], <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), coronary artery disease (OR 3.69 [95% CI 1.52\u20138.97], <jats:italic>P<\/jats:italic>\u2009=\u20090.004), obesity (OR 4.74 [95% CI 2.57\u20138.74], <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), longer SSc disease duration (OR 1.04 [95% CI 1.01\u20131.06], <jats:italic>P<\/jats:italic>\u2009=\u20090.004), diffusing capacity for carbon monoxide \u226460% of predicted (OR 2.41 [95% CI 1.40\u20134.16], <jats:italic>P<\/jats:italic>\u2009=\u20090.002), and history of scleroderma renal crisis (OR 3.18 [95% CI 1.12\u20139.07], <jats:italic>P<\/jats:italic>\u2009=\u20090.031) were all independently associated with an increased risk of DD. Anti\u2013Scl\u201070 positivity (OR 0.49 [95% CI 0.26\u20130.93], <jats:italic>P<\/jats:italic>\u2009=\u20090.03) and severe gastrointestinal disease (OR 0.48 [95% CI 0.30\u20130.79], <jats:italic>P<\/jats:italic>\u2009=\u20090.004) were associated with a reduced risk of DD. The presence of DD was independently associated with an increase in the risk of mortality (hazard ratio 1.69 [95% CI 1.07\u20132.68], <jats:italic>P<\/jats:italic>\u2009=\u20090.027).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>DD is independently associated with an increased risk of mortality in patients with SSc. Potentially modifiable risk factors, including coronary artery disease and obesity, should be addressed in patients with SSc to reduce mortality risk.<\/jats:p><\/jats:sec>","DOI":"10.1002\/art.42054","type":"journal-article","created":{"date-parts":[[2021,12,20]],"date-time":"2021-12-20T04:04:42Z","timestamp":1639973082000},"page":"849-859","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Diastolic Dysfunction in Systemic Sclerosis: Risk Factors and Impact on Mortality"],"prefix":"10.1002","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6635-0383","authenticated-orcid":false,"given":"Alicia M.","family":"Hinze","sequence":"first","affiliation":[{"name":"Mayo Clinic  Rochester Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Perin","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrianne","family":"Woods","sequence":"additional","affiliation":[{"name":"Johns Hopkins University  Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura K.","family":"Hummers","sequence":"additional","affiliation":[{"name":"Johns Hopkins University  Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredrick M.","family":"Wigley","sequence":"additional","affiliation":[{"name":"Johns Hopkins University  Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Mukherjee","sequence":"additional","affiliation":[{"name":"Johns Hopkins University  Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ami A.","family":"Shah","sequence":"additional","affiliation":[{"name":"Johns Hopkins University  Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,3,30]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.111582"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2009.114264"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-015-3382-2"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2014.04.001"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.07.068"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/03009742.2016.1206963"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.289.2.194"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jex252"},{"key":"e_1_2_6_10_1","first-page":"S30","article-title":"Prevalence, prognosis, and factors associated with left ventricular diastolic dysfunction in systemic sclerosis","volume":"30","author":"Hinchcliff M","year":"2012","journal-title":"Clin Exp Rheumatol"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.10.063"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2004.11.001"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2006.057760"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jew082"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.38098"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780230510"},{"key":"e_1_2_6_17_1","first-page":"202","article-title":"Scleroderma (systemic sclerosis): classification, subsets and pathogenesis","volume":"15","author":"LeRoy EC","year":"1988","journal-title":"J Rheumatol"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.159.1.9712108"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-5231(05)70057-5"},{"key":"e_1_2_6_20_1","first-page":"S42","article-title":"Assessment of disease severity and prognosis","volume":"21","author":"Medsger TA","year":"2003","journal-title":"Clin Exp Rheumatol"},{"key":"e_1_2_6_21_1","first-page":"2159","article-title":"A disease severity scale for systemic sclerosis: development and testing","volume":"26","author":"Medsger TA","year":"1999","journal-title":"J Rheumatol"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2014.10.003"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/0471249688"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1214\/aos\/1176345976"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1080\/10629360600810434"},{"key":"e_1_2_6_26_1","volume-title":"a language and environment for statistical computing","author":"R\u2010Core\u2010Team. 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