Impact of Cardiac Magnetic Resonance Imaging with T1 Mapping and Multi-b Value Diffusion-Weighted Sequences in Systemic Sclerosis for the Assessment of Myocardial Microscopic Fibrosis and Perfusion

Benjamin Terrier¹, Hervé Gouya², Alice Berezne¹, Alexis Regent³, Pascal Cohen¹, Loïc Guillevin⁴, Claire Le Jeunne⁵, Paul Legmann², Olivier Vignaux⁶ and Luc Mouthon⁷, ¹Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Paris, France, ²AP-HP Cochin Hospital, Department of Radiology B, Paris, France, ³Service de médecine interne, Hôpital Cochin, Paris, France, ⁴Internal Medicine, Hopital Cochin, Paris, France, ⁵Department of Internal Medicine, Hotel-Dieu Hospital, AP-HP, Paris, Paris, France, ⁶Radiology, Cochin University Hospital, Paris, France, ⁷Department of Internal Medicine, Department of Internal Medicine, Cochin Hospital, Referent Center for Necrotizing Vasculitis and Systemic Sclerosis, Paris-Descartes University, AP-HP, Paris, France

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: fibrosis, Imaging, 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: Systemic sclerosis (SSc) is a complex disease associating vasculopathy, cutaneous and visceral fibrosis, and autoimmunity. Myocardial microscopic fibrosis may occur and potentially lead to impaired myocardial contraction or cardiac conduction. Cardiac magnetic resonance imaging (CMRI) is now widely used for the non-invasive characterization of myocardium. The aim of this study is to evaluate the impact of CMRI with T1 mapping and multi-b value diffusion-weighted sequences in SSc for the assessment of myocardial fibrosis and perfusion.

Methods: We conducted a single-center prospective study of consecutive patients with SSc. CMRI with T1 mapping and multi-b value diffusion-weighted sequences were performed in all patients. T1 mapping sequences assess collagen myocardial infiltration, defining microscopic fibrosis. Multi-b value diffusion-weighted sequences assess tissue perfusion by measuring F coefficient.

Results: Forty patients, 35 women and 5 men, mean age 54.7 ± 14.6 years, were included. Patients had: diffuse cutaneous forms in 19 cases, limited cutaneous forms in 16 cases, and limited forms in 5 cases. Median modified Rodnan skin score was 6 (0-38) and median time from disease diagnosis to CMRI was 77 months (1-302).

Myocardial microscopic fibrosis, defined on T1 mapping sequences by a value greater than 1250 ms, was found in 21 (53%) SSc patients. Conversely, it was found in none of 20 healthy controls (12 males and 8 females, mean age 28 years).

Demographic characteristics were similar between SSc patients with and without myocardial microscopic fibrosis on CMRI. However, SSc patients with myocardial microscopic fibrosis had more frequent diffuse cutaneous form (67% vs. 26%, P=0.01), higher modified Rodnan skin score (11 vs. 2, P = 0.036) and more frequent infiltrative lung disease (48% vs. 16%, P=0.046). Patients with early diffuse cutaneous form (less than 4 years of evolution) had myocardial microscopic fibrosis in 86%. Patients with anti-RNA polymerase III antibody, anti-Scl70 or anti-fibrillarin antibodies, associated with diffuse cutaneous forms had myocardial microscopic fibrosis in 83%. Conversely, patients with anti-centromere antibodies had a myocardial microscopic fibrosis in 46%.

Analysis of F coefficient in multi-b value diffusion-weighted sequences revealed a perfusion defect (defined by a factor F <0.5) in 25% of SSc patients. All of these patients (100%) had a myocardial microscopic fibrosis, while only 37% of patients without perfusion defect had myocardial microscopic fibrosis (P=0.0005).

Finally, in patients with myocardial microscopic fibrosis, the use of arterial vasodilators was associated with improved tissue perfusion with an F coefficient >0.5 in 67% compared to 29% in patients not receiving arterial vasodilators.

Conclusion: This study investigates for the first time CMRI with T1 mapping and multi-b value diffusion-weighted sequences in SSc. Myocardial microscopic fibrosis is observed in half of the patients, especially in those with diffuse cutaneous forms. Microscopic fibrosis was strongly associated with myocardial perfusion defect, with a beneficial effect of arterial vasodilators on myocardial perfusion.

Disclosure: B. Terrier, None; H. Gouya, None; A. Berezne, None; A. Regent, None; P. Cohen, None; L. Guillevin, None; C. Le Jeunne, None; P. Legmann, None; O. Vignaux, None; L. Mouthon, None.

To cite this abstract in AMA style:

Terrier B, Gouya H, Berezne A, Regent A, Cohen P, Guillevin L, Le Jeunne C, Legmann P, Vignaux O, Mouthon L. Impact of Cardiac Magnetic Resonance Imaging with T1 Mapping and Multi-b Value Diffusion-Weighted Sequences in Systemic Sclerosis for the Assessment of Myocardial Microscopic Fibrosis and Perfusion [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/impact-of-cardiac-magnetic-resonance-imaging-with-t1-mapping-and-multi-b-value-diffusion-weighted-sequences-in-systemic-sclerosis-for-the-assessment-of-myocardial-microscopic-fibrosis-and-perfusion/. Accessed .

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