Session Information
Date: Sunday, November 8, 2015
Title: Sjögren's Syndrome Poster I: Clinical Insights into Sjögren's Syndrome
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Primary Sjögren syndrome (pSS) shares many clinical, inflammatory, and immunological features with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). SLE and RA are characterized by a high risk of cardiac involvement. However, there are limited data on the risk of overt cardiac involvement in pSS. We sought to use a cardiac magnetic resonance imaging (CMR) approach to assess cardiac involvement and determine its association with disease characteristics in pSS patients without cardiac symptoms.
Methods: Consecutive pSS patients, according to ACR classification criteria (2012), without a history or clinical findings of hypertension, cardiovascular disease, diabetes, or dyslipidemia underwent contrast CMR. Late gadolinium enhancement (LGE) was obtained for the assessment of myocardial fibrosis. Using a black-blood T2-weighted image (T2-WI), myocardial inflammation could be assessed. Sjögren syndrome disease activity index (ESSDAI) was determined. Eighty percent patients had documentation of a minor salivary gland biopsy. Salivary gland biopsy data were classified by focus score (FS). We investigated the patients in terms of prevalence of CMR abnormalities and explored possible associations between CMR abnormalities and pSS disease characteristics.
Results: Thirty-six female pSS patients were enrolled (mean age: 55.9 ± 7.1 years). On average, cardiovascular risk was low for the group, with patients demonstrating no ECG abnormalities, and the patients had generally low traditional cardiovascular risk factors, with a mean Framingham 10-year hard cardiovascular risk score of 4% ± 2%. The mean ESSDAI was 3.5 ± 2.1. Twelve pSS patients (33%) demonstrated myocardial abnormalities. T2-WI was seen in 4 pSS patients (11%). LGE was found in 11 pSS patients (30%), 3 of whom also demonstrated T2-WI. The main finding observed in 7 of these 11 patients (63%) was a linear pattern without coronary distribution. A patchy nodular enhancement pattern was observed in 4 patients (36%). Compared with LGE- and T2-WI-negative patients, LGE- and T2-WI-positive patients showed no significant difference related to ESSDAI. Anti-SSB antibodies were significantly higher in LGE-positive than LGE-negative patients (p = 0.002). Raynaud phenomenon was significantly associated with LGE- and T2-WI-positive patients (p = 0.006 and p = 0.04, respectively). Other pSS characteristics such as disease duration, commodities, and cardiovascular risk factors were not significantly associated with myocardial abnormalities. The greatest relative difference between LGE-positive and -negative patients was observed in focus score ≥ 3, with an adjusted odds ratio of 3.0. After adjusting for confounding by age, pSS duration, and anti-SSB antibodies, the association of LGE with Raynaud phenomenon remained significant (p = 0.023).
Conclusion: Subclinical myocardial involvement, as detected by cardiac MRI, was frequent in pSS patients without cardiac symptoms. Our results suggest that Raynaud phenomenon has a role in promoting cardiac involvements in patients with pSS.
To cite this abstract in AMA style:
Ikumi N, Kobayashi H, Kobayashi Y, Inomata H, Nagasawa Y, Sugiyama K, Karasawa H, Nozaki T, Shiraiwa H, Iwata M, Kitamura N, Matsukawa Y, Takei M. Assessment of Myocardial Abnormalities in Primary Sjögren Syndrome Using a Comprehensive Cardiac Magnetic Resonance Approach [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/assessment-of-myocardial-abnormalities-in-primary-sjogren-syndrome-using-a-comprehensive-cardiac-magnetic-resonance-approach/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessment-of-myocardial-abnormalities-in-primary-sjogren-syndrome-using-a-comprehensive-cardiac-magnetic-resonance-approach/