Are troponin and B-type natriuretic peptides useful biomarkers for the diagnosis of systemic sclerosis heart involvement? A systematic literature review

Ross, Laura; Moxey, Jayne; Nikpour, Mandana

doi:10.1016/j.semarthrit.2020.10.016

Cited by 19 publications

(12 citation statements)

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“…Abnormalities identified with cardiac MRI in some humans with diseases that result in subclinical myocarditis and myocardial fibrosis do not always correlate well with cTnI concentrations; instead, cTnI concentrations were associated more commonly with clinically important arrhythmias, echocardiographic changes, and congestive heart failure. 49 A previous postmortem study of dogs with MMVD found correlations between cTnI concentrations and myocardial fibrosis and arteriosclerosis, but it is possible that serum cTnI concentrations increase with early myocardial abnormalities that cannot be identified with cardiac MRI. 4 The absence of significant differences in native T1 values, postcontrast T1 values, ECV, and serum galectin-3 concentrations between groups in our study was consistent with the conclusion that dogs with advanced MMVD may not develop myocardial fibrosis more than what occurs in healthy older dogs.…”

Section: Discussionmentioning

confidence: 94%

Utility of cardiac MRI to diagnose myocardial ischemia and fibrosis in dogs with cardiomegaly secondary to myxomatous mitral valve disease

Clark

Winter

Aarnes

et al. 2022

ajvr

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OBJECTIVE To assess whether cardiac MRI or various biomarkers can be used to detect myocardial ischemia and fibrosis in dogs with cardiomegaly secondary to myxomatous mitral valve disease (MMVD). ANIMALS 6 dogs with cardiomegaly secondary to naturally occurring stage B2 MMVD being treated only with pimobendan with or without enalapril and 6 control dogs with no cardiac disease. All dogs were ≥ 5 years old with no systemic illness. PROCEDURES Serum cardiac troponin I and concentrations were measured, and dogs were anesthetized for cardiac MRI with ECG-triggered acquisition of native T1- and T2-weighted images. Gadolinium contrast was administered to evaluate myocardial perfusion and late gadolinium enhancement (LGE). Mean T1 and T2 values and regions of LGE were measured with dedicated software. Extracellular volume (ECV) was estimated on the basis of Hct and T1 values of myocardium and surrounding blood. Subjective analysis for myocardial perfusion deficits was performed. RESULTS Dogs with MMVD had significantly (P = .013) higher cardiac troponin I concentrations than control dogs, but galectin-3 concentrations did not differ (P = .08) between groups. Myocardial fibrosis was detected in 4 dogs with MMVD and 3 control dogs; no dogs had obvious myocardial perfusion deficits. Native T1 and T2 values, postcontrast T1 values, and ECV values were not significantly different between groups (all P > .3). CLINICAL RELEVANCE Results suggest that some dogs with cardiomegaly secondary to MMVD may not have clinically relevant myocardial fibrosis.

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Section: Discussionmentioning

confidence: 94%

Utility of cardiac MRI to diagnose myocardial ischemia and fibrosis in dogs with cardiomegaly secondary to myxomatous mitral valve disease

Clark

Winter

Aarnes

et al. 2022

ajvr

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“…Correlation of LVDD with biomarkers may aid the identification of patients with HFpEF as well as assisting in the stratification of patients into high and low risk groups. Elevated troponin and BNP have both been shown to be useful prognostic markers in SSc, identifying those patients with cardiac abnormalities at increased risk of death and poor cardiac outcome (21,22).…”

Section: Discussionmentioning

confidence: 99%

The clinical implications of left ventricular diastolic dysfunction in systemic sclerosis

Ross

Patel

Stevens

et al. 2022

Clinical and Experimental Rheumatology

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ObjectiveWe sought to quantify the burden of left ventricular diastolic dysfunction (LVDD) and heart failure with preserved ejection fraction (HFpEF) in systemic sclerosis (SSc) and assess the progression of LVDD over time and its prognostic importance. Methods Two-hundred and twenty-five participants enrolled in the Australian Scleroderma Cohort Study were included and LVDD was assessed according to 2016 ASE/EACVI Guidelines. Logistic regression analyses and generalised estimating equations were performed to evaluate the relationship between LVDD and SSc disease characteristics and symptomsand signs of heart failure, respectively. The relationship between LVDD and mortality was assessed using Kaplan-Meier survival estimates. ResultsThirty-four (15%) participants were diagnosed with LVDD. A further 89 (40%) participants had indeterminate diastolic function. Older age (p<0.01), hypertension (p=0.02), impaired systolic function (p=0.03) and interstitial lung disease (p=0.01) were all associated with the presence of LVDD. There was no association between the presence of LVDD and clinical signs of heart failure, however, LVDD was associated with more breathlessness and worse functional class (p=0.03). LVDD was observed to progress over time, with significant worsening of parameters of left ventricular filling pressure. There was no significant relationship between LVDD and mortality (p=0.23). ConclusionAbnormal diastolic function is a common finding in SSc, progresses over time and is associated with more severe dyspnoea. Whilst patients with LVDD are more breathless, LVDD is not clearly associated with clinical findings of heart failure demonstrating that LVDD may be of importance in explaining symptoms even in the absence of HFpEF in SSc.

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“…Furthermore, widely established biomarkers including BNP as well as its prohormone, Nterminal-proBNP are nonspeci c and may be also elevated in SSc-PH (49)(50)(51). Serum autoantibodies and clinical features are only marginally helpful in assessing the risk for cardiac brosis in SSc with con icting reports from multiple studies (52,53). Lastly, there is a lack of a consensus de nition for what constitutes cardiac involvement in SSc (54).…”

Section: Discussionmentioning

confidence: 99%

Periostin overexpression in scleroderma cardiac tissue and its utility as a marker for disease complications

El-Adili

Lui

Najem

et al. 2022

Preprint

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Objective To evaluate the levels of periostin in patients with systemic sclerosis (SSc) and their association with features of systemic sclerosis. Methods The levels of periostin were assessed in the serum of 106 SSc patients and 14 healthy controls, and by immunofluorescence staining in cardiac tissue from 4 SSc patients and 4 healthy controls. Serum periostin was measured via enzyme-linked immunosorbent assay, and the natural logarithm of periostin (log-periostin) was calculated. Results were analyzed using unpaired t-test or one-way ANOVA followed by Tukey’s multiple comparisons tests, and Pearson’s test for correlations. Cardiac tissue from SSc patients and controls was stained for periostin and co-stained for periostin and collagen type I using immunofluorescence. Results Periostin levels were higher in patients with SSc compared to controls, and directly correlated to modified Rodnan skin score and echocardiography parameters of left ventricular measurements. Immunofluorescence staining in SSc cardiac tissue showed patchy periostin expression in all SSc patients, but not in controls. Furthermore, there was extensive periostin expression even in areas without collagen deposition, while all established fibrotic areas showed co-localization of collagen and periostin. There was no association between periostin levels and interstitial lung disease, pulmonary hypertension or other vascular complications. Conclusion Periostin is elevated in SSc cardiac tissue in vivo and circulating levels of periostin are increased in SSc, correlating with the extent of disease duration, degree of skin fibrosis, and left ventricular structural assessments. Periostin may be a potential biomarker that can provide further pathogenic insight into cardiac fibrosis in SSc.

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Are troponin and B-type natriuretic peptides useful biomarkers for the diagnosis of systemic sclerosis heart involvement? A systematic literature review

Cited by 19 publications

References 50 publications

Utility of cardiac MRI to diagnose myocardial ischemia and fibrosis in dogs with cardiomegaly secondary to myxomatous mitral valve disease

Utility of cardiac MRI to diagnose myocardial ischemia and fibrosis in dogs with cardiomegaly secondary to myxomatous mitral valve disease

The clinical implications of left ventricular diastolic dysfunction in systemic sclerosis

Periostin overexpression in scleroderma cardiac tissue and its utility as a marker for disease complications

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