Background/Purpose

Systemic sclerosis (SSc) is associated with an increased prevalence of cardiac involvement despite often being clinically silent. Cardiac involvement is a major factor in decreasing SSc survival rates because it is associated with a 70% 5-year mortality rate. Cardiac magnetic resonance imaging (CMR) is useful in SSc since it focuses on late gadolinium enhancement (LGE) abnormalities, ventricular morphology, and function. Our study aimed to comprehensively analyze CMR and investigate the association between CMR findings and brain natriuretic peptide (BNP) in SSc patients (pts) without cardiac symptoms.

 Methods

Consecutive female pts with SSc without cardiac symptoms as well as healthy female controls were enrolled. SSc pts and control subjects with no history or clinical findings of systemic and pulmonary hypertension determined by echocardiography, coronary artery disease, valvular heart disease, atrial fibrillation, diabetes mellitus, and dyslipidemia underwent non-contrast or contrast CMR on a 1.5T scanner. Left ventricular (LV) function was measured using LV 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 the LVM/body surface area. LGE was obtained to assess myocardial fibrosis. Myocardial inflammation was assessed with black blood T2-WI. Serum BNP concentrations were measured simultaneously in all participants.

Results

We compared 35 SSc pts (mean age, 55.9±7.1 years)—19 with diffuse type and 16 with limited type—with 20 healthy controls (mean age, 56.9±3.1 years). There were no significant differences in characteristics such as age, gender, and cardiovascular risk factors, between SSc and control group. Compared with the control group, the SSc group had a significant higher EDV with tendency toward a high LVMI. There was no difference in EF between the control and SSc groups. SSc with LGE was detected in 16 of 35 pts (46%). The main finding observed in 9 of these 16 (56%) pts was a linear pattern without coronary distribution. A patchy nodular enhancement pattern was observed in 7 pts (44%). LVMI and mass/EDV were significant higher in the LGE (+) group than in the LGE (-) group (P>0.001, P=0.003, respectively). T2-WI imaging showed myocardial inflammation in 6 of 35 pts (17%). The mean BNP level of the SSc group was significantly higher than that of the control group (P=0.04). The mean BNP level of the SSc with LGE group was significantly higher than that of the SSc without LGE group (P=0.023). BNP level was significantly correlated with LVMI and EF in the SSc group (P=0.04, P=0.05, respectively). After adjustment for age, disease duration, and BNP, the SSc with LEG group did not have a modified association with LVMI. 

Conclusion

SSc patients without cardiac symptoms have a high prevalence of cardiac abnormalities. SSc patients with LGE had abnormal morphology associated with LVMI and serum BNP even with a normal EF. Further studies are needed to determine whether CMR abnormalities affect prognosis or treatment strategy.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/early-detection-of-left-ventricular-morphological-functional-abnormalities-and-myocardial-characteristics-in-systemic-sclerosis-without-cardiac-symptoms-using-cardiac-magnetic-resonance-imaging-a-pr/