Background In patients with systemic sclerosis (SSc), myocardial involvement is common, may have serious consequences, and may lead to a poor prognosis. Regional left ventricular (LV) dysfunction reflects myocardial involvement. The regional LV function in SSc has not been systematically studied using cardiac magnetic resonance (CMR) imaging. Combining perfusion and delayed enhancement MR imaging together may reveal important clues to the pathophysiologic mechanisms of myocardial involvements in SSc.
Objectives We aimed to detect LV regional dysfunction and myocardial abnormalities in patients with SSc without cardiac symptoms using a CMR approach.
Methods Consecutive patients with SSc who had no past history or current clinical findings of hypertension, coronary artery disease, valvular heart disease, atrial fibrillation, diabetes mellitus, dyslipidemia, or echocardiographic abnormalities and healthy controls underwent CMR on a 1.5 T scanner. Peak systolic regional radial strain (Err, %) was calculated from a feature tracking analysis on mid-left ventricular slices obtained with cine MRI in six segments. Furthermore, stress perfusion scan was performed to assess perfusion defects (PD) due to micro or macrovascular impairment, and delayed enhancement (DE) images were obtained d for the assessment of myocarditis and/or fibrosis. We compared the patients and controls in terms of prevalence of CMR abnormalities, and explored possible associations between CMR abnormalities and SSc disease characteristics. Group comparisons were made using the Wilcoxon Chi-square test, and the Tukey-Kramer’s test and Fisher’s exact test.
Results We compared 19 patients with SSc (100%female; mean age, 58.8±8.7 years; 10 had limited cutaneous SSc and 9 diffuse cutaneous SSc) with 10 healthy controls (100% female; mean age, 55.7±4.52 years). No statistically significant differences were observed in baseline characteristics between the patients and healthy controls. The mean peak Err of all segments was significantly lower in the patients than the controls (0.49±0.04 vs.0.69±0.05; p=0.008).The mean peak Err of the patients with limited cutaneous SSc tended to be lower than those with diffuse cutaneous SSc (p=0.18). The mean peak Err of patients with digital ulcer tended to be lower than those without it (p=0.36). Other SSc characteristics were not associated with the mean peak Err. Five patients with DE (26.3%) and 11 patients with PD (57.9%) were observed. The mean peak Err in the patients with PD and DE tended to be lower than in those without PD (p=0.18) and DE (p=0.17). PD was significantly associated with digital ulcer (p=0.0003).
Conclusions Subclinical myocardial involvement, as detected by CMR, was prevalent in the SSc patients without cardiac symptoms. Evaluation with CMR appears to be useful in detecting subclinical myocardial involvement in SSc. Regional LV dysfunction and PD may associate with digital ulceration. Our findings could suggest a pathophysiological mechanism to explain the relationship between myocardial abnormalities and digital ischemia in SSc.
Disclosure of Interest None Declared
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