Cardiac magnetic resonance imaging in systemic sclerosis: a cross-sectional observational study of 52 patients

Anne-Lise Hachulla ¹, David Launay ^2*, Virginia Gaxotte ¹, Pascal de Groote ³, Nicolas Lamblin ³, Patrick Devos ⁴, Pierre-Yves Hatron ², Jean-Paul Beregi ¹ and Eric Hachulla ²

¹ Department of Cardiovascular Radiology, France
² Department of Internal Medicine, France
³ Department of Cardiology, France
⁴ Department of Statistics, France

^* To whom correspondence should be addressed. E-mail: d-launay{at}chru-lille.fr.

Accepted 18 November 2008

Abstract

Objectives: To assess the prevalence and patterns of cardiac abnormalities as detected by cardiac magnetic resonance imaging (MRI) in systemic sclerosis (SSc).

Methods: Fifty-two consecutive patients with SSc underwent cardiac MRI to determine morphological, functional, perfusion at rest, and delayed enhancement abnormalities.

Results: At least one abnormality on cardiac MRI was observed in 39/52 (75%) patients. Increased myocardial signal intensity in T2 was observed in 6 patients (12%), thinning of left ventricle (LV) myocardium in 15 patients (29%), and pericardial effusion in 10 patients (19%). LV and right ventricle (RV) ejection fractions were altered in 12 patients (23%) and 11 patients (21%), respectively. LV diastolic dysfunction was found in 15/43 patients (35%). LV kinetic abnormalities were found in 16/52 (31%) patients. Myocardial delayed contrast enhancement was detected in 11 patients (21%). No perfusion defects at rest were detected. Patients with limited SSc had similar MRI abnormalities to patients with diffuse SSc. Seven out of 40 patients (17%) without pulmonary arterial hypertension had RV dilatation.

Conclusions: Our study showed that MRI is a reliable and sensitive technique to diagnose heart involvement in SSc and to analyse its mechanisms, including its inflammatory, microvascular and fibrotic components. Compared to echocardiography, MRI appears to provide additional information by visualising myocardial fibrosis and inflammation. RV dilatation appeared to be non-specific for pulmonary arterial hypertension but could also reflect myocardial involvement related to SSc. Further studies are needed to determine whether cardiac MRI abnormalities have an impact on prognosis and treatment strategy.