The studies in the thesis include up to 333 patients with systemic sclerosis treated at Oslo University Hospital between 2003 and 2016. More than half of them were assessed with cardiac ultrasound twice.

(1) 17% of patients were diagnosed with left ventricular diastolic dysfunction at baseline. The proportion increased to 29% after a median follow-up period of 3.4 years. 57% of patients with baseline diastolic dysfunction died during follow-up, compared to only 13% of the patients with normal function.

Diastolic dysfunction was a stronger predictor of death than pulmonary hypertension. Half of the 86 patients who had performed right heart catheterization had pulmonary hypertension, of which 60% died during follow-up.

(2) 12% of the patients had an ejection fraction below 50%, and 24% had global longitudinal strain greater than −17.0%, indicating left ventricular systolic dysfunction. The proportions were stable during 3.3 years follow-up. 10% had right ventricular systolic dysfunction measured with TAPSE at baseline, increasing to 15% at follow-up. Only right ventricular systolic function independently predicted mortality.

(3) The levels of tumor necrosis factor related apoptosis (TRAIL) in blood associate with both left ventricular diastolic dysfunction and right ventricular systolic dysfunction in systemic sclerosis. Moreover, patients with right ventricular systolic dysfunction also have higher levels of osteopontin and antiopoietin-2. Changes in all these markers over time predict mortality.