Background/Purpose: Systemic sclerosis (SSc) is a rare connective tissue disease with pronounced alterations of the microvascular system, frequent cellular and humoral immunity abnormalities and fibroblast dysfunction. All these events result in an overproduction of collagen with possible involvement of skin and internal organs. Cardiac involvement is common in SSc; it is often asymptomatic and insidious, but almost invariably associated with ominous outcome. For this reason it is essential to identify markers useful to early recognize any sort of SHI. The aim of this study was to investigate if  high sensitivity troponin (HSTn) could be helpful  to identify subclinical SHI.

Methods: for this purpose we analyzed data of 65 consecutive SSc patients (M:F = 4:61; mean age 59,4 years, range 24-95 years; mean disease duration 10,3 years; 33 with lcSSc, 32 with dcSSc) followed at our unit. Among all our SSc patients admitted in the last two years, we selected only those who underwent the following laboratory and instrumental investigations: HSTn,  electrocardiogram  and an echocardiogram within six months of HSTn test. Most of patients performed also N-terminal segment of proBNP (NT-proBNP) test and three patients underwent cardiac magnetic resonance imaging (cMRI). We excluded from our study patients with overt pulmonary arterial hypertension since it could alter cardiac markers. For six of the selected patients we collected data in more than one occasion. Furthermore we defined as SHI the presence of one or more of these conditions, in the absence of any other causes: diastolic dysfunction (at least grade II or grade I if patient is younger than 50 years or in presence of other manifestations of SHI), pericardial effusion, conduction abnormalities (bundle branch block or atrioventricular block) or arrhythmias, edema and/or T2 weighted non ischemic pattern showed by cMRI. Correlation between laboratory data and instrumental measurements were performed by non parametric tests for continuous variables and contingency tables for categorical variables (Stat-View, SAS). Fisher exact test was applied when indicated.

Results: among the analyzed patients 13 showed SHI and 23 and 29 had respectively high levels of HSTn and of NT-proBNP. SHI seems to be correlated only with high levels of HSTn (p 0,02) with a significant difference between the HSTn values of patients with or without SHI (59 versus 13ng/ml; p 0,0097). Moreover we observed a strictly correlation between NT-proBNP and HSTn: among patients with abnormal NT-proBNP, 18 had also out of range HSTn (spearman rank correlation 0,5; p <0.0001).

Conclusion: Our data shows a close relationship between HSTn and NT-proBNP in SSc patients with SHI. However, if we consider these 2 serological parameters independently, we observe that HSTn might be a marker of SHI while NT-proBNP seems to be a less specific index of heart dysfunction. Since SHI is often subclinical, but anyway associated with a significantly increased morbidity and mortality, a serological marker would be very useful not only to early diagnose SHI but also to select patients who need additional investigations such as cMRI. However further studies are necessary to confirm these preliminary results.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/might-troponin-be-a-marker-for-subclinical-scleroderma-heart-involvement-shi/