Association of Myocardial Abnormalities with Disease Characteristic and Brain Natriuretic Peptide (BNP) in Systemic Sclerosis without Cardiac Symptoms As Assessed Using Cardiac Magnetic Resonance Imaging; A Prospective Multi Center Study

Kaita Sugiyama¹, Hitomi Kobayashi², Yasuyuki Kobayashi³, Yosuke Nagasawa¹, Natsumi Ikumi⁴, Takamasa Nozaki⁵, Hirotake Inomata¹, Hidetaka Shiraiwa⁶, Hiromi Karasawa⁶, Noboru Kitamura⁷, Mitsuhiro Iwata⁵, Yoshihiro Matsukawa⁶ and Masami Takei⁵, ¹Nihon University School of Medicine, Tokyo, Japan, ²Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan, ³Advanced Biomedical Imaging Informatics, St.Marianna University School of Medicine, Kawasaki, Japan, ⁴Nihon University School of Medicine, Shinjuku, Japan, ⁵Division of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan, ⁶Division of Heamatology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan, ⁷NIhon University School of Medicine, Tokyo, Japan

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Magnetic resonance imaging (MRI), myocardial involvement and systemic sclerosis

Session Information

Date: Monday, November 9, 2015

Title: Systemic Sclerosis, Fibrosing Syndromes and Raynaud's - Clinical Aspects and Therapeutics Poster II

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: In the majority of SSc patients, however, cardiac involvement often remains subclinical. Primary myocardial abnomalities are characterized by ﬁbrosis. Cardiovascular magnetic resonance (CMR) can non-invasively detect subclinical myocardial inflammation and fibrosis. Brain natriuretic peptide (BNP) has become important cardiac biomarkers. We evaluated the association of myocardial abnormalities and LV geometry ,assessed by CMR, with disease characteristic and BNP in SSc patients without cardiac symptoms.

Methods: Patients were recruited from3 hospitals in Tokyo. This study compared consecutive female SSc patients without cardiac symptoms and healthy female controls with no history or clinical findings of systemic and pulmonary hypertension by echocardiography, coronary artery disease, valvular heart disease, atrial fibrillation, diabetes mellitus, and dyslipidemia. All underwent contrast or non-contrast CMR on a 3.0-T scanner. LV function was measured using ejection fraction (EF), end-systolic volume (ESV), end-diastolic volume (EDV), stroke volume (SV), and cardiac output (CO). LV hypertrophy was measured by absolute LV mass (LVM) and LVM index (LVMI) determined by LVM/body surface area. LGE was obtained to assess myocardial fibrosis. Myocardial inflammation was assessed by black- blood T2WI. Serum BNP concentrations were measured simultaneously.

Results: There were 50 SSc patients with a mean age of 55.1 ± 7.7 years; 25 had diffuse type and 25 had limited type. There were 20 healthy controls with a mean age of 56.9 ± 3.1 years. There were no significant differences in terms of age, gender, and cardiovascular risk factors. Compared with the control, SSc patients had a significantly higher EDV with tendency towards a high LVMI. There was no difference in EF between control and patients of SSc . LGE (+) was detected in 27 of 50 (54%) SSc patients. T2WI was observed in 13 of 50 (26%) patients of SSc. There were no differences in LGE and T2WI between the diffuse and limited type. The mean of BNP level in SSc group was significantly higher than that of the control group (P = 0.02). The mean of BNP level in SSc patients with LGE (+) was significantly higher than that of SSc patients without LGE (P < 0.001). BNP level in SSc patients was significantly correlated with LVMI (P < 0.001) but not correlated with EF. Eccentric hypertrophy was observed in 55% of LGE (+) patients. LGE (+) was correlated with anti Scl-70 antibody (P=0.004). Receiver operating characteristic analysis showed BNP reliably detected myocardial abnormalities (area under the curve 0.896; 95% confidence interval, 0.873–0.924). Considering patients with SSc with normal echocardiography, and using a 18.0 pg/ml cut-off concentration, sensitivity and specificity were 91% and 70% in the detection of overall cardiac involvement.

Conclusion: Cardiac involvement is common in SSc even in the absence of cardiac symptoms, and includes myocardial inflammation as well as myocardial fibrosis. Our data suggest that SSc-specific autoimmunity against Scl-70 mediates these changes. BNP level may be useful in future in the study of treatments aimed at preventing or reducing adverse myocardial processes in SSc.

Disclosure: K. Sugiyama, None; H. Kobayashi, None; Y. Kobayashi, None; Y. Nagasawa, None; N. Ikumi, None; T. Nozaki, None; H. Inomata, None; H. Shiraiwa, None; H. Karasawa, None; N. Kitamura, None; M. Iwata, None; Y. Matsukawa, None; M. Takei, None.

To cite this abstract in AMA style:

Sugiyama K, Kobayashi H, Kobayashi Y, Nagasawa Y, Ikumi N, Nozaki T, Inomata H, Shiraiwa H, Karasawa H, Kitamura N, Iwata M, Matsukawa Y, Takei M. Association of Myocardial Abnormalities with Disease Characteristic and Brain Natriuretic Peptide (BNP) in Systemic Sclerosis without Cardiac Symptoms As Assessed Using Cardiac Magnetic Resonance Imaging; A Prospective Multi Center Study [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/association-of-myocardial-abnormalities-with-disease-characteristic-and-brain-natriuretic-peptide-bnp-in-systemic-sclerosis-without-cardiac-symptoms-as-assessed-using-cardiac-magnetic-resonanc/. Accessed .

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