Background Cardiac involvement in systemic sclerosis (SSc) affects the prognosis of the disease. Myocardial fibrosisis the pathological hallmark of this complication and has been reported in 50–80% of cases in necropsy. Echocardiography is the routine imaging tool to easily detect cardiac involvement, but it is not accurate to detect myocardial fibrosis. Delayed gadolinium enhancement (DE) cardiovascular magnetic resonance (CMR) is the gold-standard for myocardial fibrosis assessment
Objectives To evaluate the added value of DE-CMR to echocolorDoppler in SSc patients.
Methods After a thorough clinical characterization, 53 SSc patients (age =52±14, 95% females, 34% diffuse form) underwent, on the same day, a comprehensive echocardiogram, including tissue Doppler imaging (TDI), and a DE-CMR.
Results Echocardiography showed normal systolic function (ejection fraction =64±6%) and wall motion score index (=1) in 53/53 (100%) patients, whereas DE-CMR showed a pattern of non-ischaemic myocardial fibrosis in 12/53 (23%) patients. In 2/53 patients (4%), T2-weighted CMR showed myocardial oedema, that resolved after steroid therapy. Among clinical (age, duration of disease, limited or cutaneous form, Rodnan skin score, activity score), echocardiographic (indexed left atrium and left ventricular volumes, right atrium and ventricular dimensions, 2-D and TDI parameters of left and right ventricular function and pulmonary arterial systolic pressure) and CMR parameters, only TDI mitral annulus E/E’ was an independent predictor of the presence of myocardial fibrosis at multivariate analysis (hazard ratio 1.8; 95% confidence interval 1.1-3.1).
Conclusions Subclinical cardiac involvement is relatively frequent in SSc. CMR can detect different patterns of reversible (by T2-weighted) and irreversible (by DE) cardiac involvement. Elevated E/E’ at echocardiography may raise the suspicion of myocardial fibrosis.
Disclosure of Interest None Declared
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