Background/Purpose: In previous studies we showed that prevalence of myocardial fibrosis in SSc patients is 45% and is associated to diffuse disease (dcSSc) and lower left ventricle ejection fraction (LVEF); microvascular damage was also very frequent (79%). Our aim was to identify baseline characteristics associated to the development of cardiovascular outcomes (heart failure, coronary artery disease, arrhythmias, vasculopathy, and death) in SSc patients with previously documented myocardial fibrosis and microvascular damage.

Patients and Methods: We included 62 SSc patients who participated in the study of prevalence of myocardial fibrosis (2008-2010) and in our local SSc cohort. We performed baseline clinical evaluation, cardiac MRI, coronary angiotomography, transthoracic echocardiogram, and yearly clinical and cardiovascular evaluation that included Medsger’s severity scale items, electrocardiogram, echocardiogram, chest X ray or HRCT and spirometry; we registered presence and severity of internal organ involvement and cardiovascular outcomes. Ordinal variables were analyzed using Chi square test and Fisher test when appropriate, numeric variables were compared using Student’s t test or Mann Whitney U when appropriate, logistic regression was used to perform multivariable analysis.

Results: We obtained follow-up information from 61 patients (29 dcSSc, 32 lcSSc), mean follow up was 43.5 months. Univariate analysis showed that elevated basal ultrasensitive CRP was associated to higher overall mortality at the end of follow-up (p=0.003, OR=22, 95% CI 2.3-209), and microvascular damage at baseline was associated to recurrent digital tip ischemic ulcers (p=0.05). Multivariable analysis showed that: myocardial fibrosis, particularly in the middle LV segments was associated to the development of heart failure (p=0.04, OR 8.9, 95%CI 1.07-76); lower LVEF was associated to the development of coronary artery disease (p=0.02, OR 0.66, 95%CI 0.47-0.9); finally, insertion point fibrosis (p=0.01, OR 11.1, 95%CI 2.5-55.5) and elevated ultrasensitive CRP (p=0.04, OR 5.2, 95%CI 1.82-25.6) were associated to recurrent digital tip ulcers.

Conclusion: This study shows that elevated ultrasensitive CRP, the presence of myocardial fibrosis and microvascular damage are predictors of cardiovascular outcomes in SSc patients. Patients with myocardial fibrosis experience progressive decline in LVEF when compared to those without fibrosis. Future studies should focus on therapeutic strategies for this group of patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/myocardial-fibrosis-detected-by-magnetic-resonance-imaging-is-a-predictor-of-heart-failure-in-systemic-sclerosis-ssc-patients/