Date: Sunday, November 5, 2017
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Cardiac involvement is a relevant prognostic determinant of outcome in Systemic Sclerosis (SSc). Since the role of cardiac MRI (CMR) is still uncertain, we examined the cardiac involvement in symptomatic SSc patients through CMR, and defined its prognostic role value and its modification over the time.
Sixty-two SSc-patients with symptoms of cardiac involvement (dyspnea, palpitations) and/or signs of cardiac failure and elevation of cardiac enzymes (MB-CK and/or troponin T) underwent C-MRI. Patients were followed for 51.0±27.2 months and 23 patients underwent a serial C-MRI studies because of modification and/or a worsening of their symptoms and signs.
CMR demonstrated abnormalities in 67.7% of patients, in particular T2 hyperintensity in 6 (9.7%) patients, while none of the patients presented early gadolinium enhancement and 20 (32.2%) patients presented late gadolinium enhancement (LGE). We identified 3 different patterns of distribution of LGE: subepicardial, midwall and subendocardial. Fourteen patients presented a single pattern of distribution (22.6%), while 6 patients (9.7%) presented more than one: 20.9% of patients presented a midwall distribution of LGE, 8.1% of patients presented a subepicardial LGE with a linear distribution pattern and 9.7% presented a subendocardial LGE distribution. Twelve patients (19.4%) showed one hypokinetic area and three patients akinetic areas. After a mean follow-up of 51.0±27.2 months, 4 patients (6.0%) died for arrhythmias or heart failure and 75% presented a subendocardial DE distribution pattern (p=0.003).
During the follow-up, 23 SSc patients presented a modification and/or a worsening of their cardiac symptoms and signs and they repeated the CMR assessment; CMR abnormalities were partially confirmed in 12 in the subsequent evaluation, 5 CMR demonstrated the development of new areas of T2 hyperintensity, subepicardic and subendocardic DE and ipo/akinesia; finally 7 CMR previously negative remained negative despite new symptoms. Furthermore a statistical significant reduction of the ejection fraction (EF) of left (59.4±10.6 vs 56.1±11.3, p<0.001) and right ventricles (54.6±12.0 vs 52.1±12.3, p<0.001) was noticed over the time.
CMR represents a useful tool to assess the cardiac involvement in systemic sclerosis patients with cardiac signs and symptoms. Yet clear-cut links between each CMR finding and cardiac symptoms needs to be better defined Our data suggest that CMR offers the most comprehensive assessment of the extension of myocardial damage and identifies patients with a poor cardiac outcome especially when a subendocardial DE is present. Serial CMR evaluations allow to identify the new cardiac damage and to follow reduction of EF of both ventricles.
To cite this abstract in AMA style:Bosello S, Canestrari G, De Lorenzis E, Natalello G, Parisi F, Meduri A, Marano R, Ferraccioli G, Gremese E. Cardiac MRI in Systemic Sclerosis As Prognostic Tool of Cardiac Mortality in Symptomatic Patients [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/cardiac-mri-in-systemic-sclerosis-as-prognostic-tool-of-cardiac-mortality-in-symptomatic-patients/. Accessed November 11, 2019.
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