Asymptomatic myocardial dysfunction was revealed by feature tracking cardiac magnetic resonance imaging in patients with primary Sjögren’s syndrome

Yokoe, Isamu; Kobayashi, Hitomi; Nishiwaki, Atsuma; Nagasawa, Y.; Kitamura, Noboru; Haraoka, Masaki; Kobayashi, Yasuyuki; Takei, Masami; Nakamura, Hideki

doi:10.1111/1756-185x.14227

Cited by 7 publications

(11 citation statements)

References 35 publications

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“…Hypertension and COPD appear more prevalent in the PDF group whereas peripheral vascular disease and infections are more prevalent in the HSB group, amongst others. Several studies have identified that PSS patients have a higher risk for cardiovascular disease ( 8 – 10 , 20 ), it is possible that these patients are more likely to be in the HSB group. The comorbidities associated with the LSB and DDF groups appear to be more limited.…”

Section: Discussionmentioning

confidence: 99%

Comorbidities in the UK Primary Sjögren’s Syndrome Registry

et al. 2022

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IntroductionPrimary Sjögren’s Syndrome (PSS) is a c0hronic disease characterised by symptoms of oral and ocular dryness, pain, fatigue, anxiety and depression. PSS patients can be subclassified by the pattern of severity of these five key symptoms using the Newcastle Sjögren’s Stratification Tool (NSST). Although PSS is often associated with one or more comorbidities, the relationship between comorbidities, polypharmacy, and PSS symptom burden is unclear. Using data from the UK Primary Sjögren’s Syndrome Registry (UKPSSR) we describe the landscape of polypharmacy and comorbidities in PSS.MethodsThe UKPSSR is research biobank of clinically well-defined PSS patients where clinical, demographic, comorbidities and concomitant medications data are recorded. Patients were subclassified into the four NSST subgroups: Low Symptom Burden (LSB), High Symptom Burden (HSB), Dryness Dominated Fatigue (DDF) and Pain Dominated Fatigue (PDF). Group analyses of comorbid conditions and polypharmacy scores were performed. Comorbidity and Polypharmacy Scores (CPS) were modelled as a function of age, sex, symptom duration, body mass index (BMI), current immunosuppressant and hydroxychloroquine prescriptions and NSST subgroup.ResultsThere were marked differences in the number and the nature of comorbidities associated with the NSST subgroups. LSB and DDF patients were characterized by fewer comorbidities and medications. In contrast, HSB and PDF patients were associated with more comorbidities and were more likely to be prescribed multiple medications. Group analysis shows that HSB patients are more closely associated with peripheral vascular disease and infection whereas the PDF patients were associated with cardiovascular disease and gastrointestinal comorbidities. Comorbidity and polypharmacy scores increase with age and BMI regardless of symptom subgroup and symptom duration. In addition, the longer the reported symptom duration the higher the associated comorbidities and polypharmacy scores.ConclusionComorbid conditions are more prevalent in some subgroups of the PSS cohort but increase with age and BMI across the entire cohort. It is unclear from these data whether specific comorbid conditions are a consequence of PSS or represent shared aetiology or pathogenetic susceptibility. Regardless, these findings may have implications for disease management and clinical trial design.

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Section: Discussionmentioning

confidence: 99%

Comorbidities in the UK Primary Sjögren’s Syndrome Registry

et al. 2022

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“…Indeed, it was also reported that myocardial injury is typically clinically silent in patients with RA, and this could explain the lack of data on cardiac events in patients with SS, since clinical and pathophysiological characteristics are often shared between RA and SS. In recent papers, it was a high prevalence of myocardial fibrosis in the patients with SS who underwent to cardiac magnetic resonance imaging (cMRI) was observed, which can be used to obtain a quantitative functional evaluation of the myocardium [ 42 , 43 ]. In these studies, emerging data highlight that lymphocytic infiltration into the myocardium is conceivable as a pathological characteristic of myocardial fibrosis in SS patients.…”

Section: Clinical Fibrotic Manifestation In Ssmentioning

confidence: 99%

“…In fact, myocardial fibrosis is present in patients with SS without cardiac symptoms, and alterations in cMRI data were often linked with SG focus score (FS) ≥ 3 [ 42 , 44 ]. This study suggests a significant association between myocardial fibrosis and the degree of lymphocytic infiltration into the SGs as an important prognosis factor for SS [ 43 ]. Yokoe et al, in an interesting study, have obtained several important results from the observation of a representative number of SS patients by the use of non-contrast cMRI, without cardiovascular clinical symptoms [ 43 ].…”

Section: Clinical Fibrotic Manifestation In Ssmentioning

confidence: 99%

“…This study suggests a significant association between myocardial fibrosis and the degree of lymphocytic infiltration into the SGs as an important prognosis factor for SS [ 43 ]. Yokoe et al, in an interesting study, have obtained several important results from the observation of a representative number of SS patients by the use of non-contrast cMRI, without cardiovascular clinical symptoms [ 43 ]. These findings suggest and confirm that cardiac dysfunction and cardiac fibrosis are strongly evident in SS patients.…”

Section: Clinical Fibrotic Manifestation In Ssmentioning

confidence: 99%

“…These findings suggest and confirm that cardiac dysfunction and cardiac fibrosis are strongly evident in SS patients. Furthermore, the importance of this study was to demonstrate that myocardial fibrosis could be considered as an extra-glandular event of SS [ 43 ], and that cMRI could be a useful tool for detecting asymptomatic myocardial fibrosis in patients with SS with a higher SG FS [ 42 ].…”

Section: Clinical Fibrotic Manifestation In Ssmentioning

confidence: 99%

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Sjögren’s Syndrome-Related Organs Fibrosis: Hypotheses and Realities

Sisto

Ribatti

Lisi

2022

JCM

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Sjögren’s syndrome (SS) is a systemic chronic autoimmune disorder characterized by lymphoplasmacytic infiltration of salivary glands (SGs) and lacrimal glands, causing glandular damage. The disease shows a combination of dryness symptoms found in the oral cavity, pharynx, larynx, and vagina, representing a systemic disease. Recent advances link chronic inflammation with SG fibrosis, based on a molecular mechanism pointing to the epithelial to mesenchymal transition (EMT). The continued activation of inflammatory-dependent fibrosis is highly detrimental and a common final pathway of numerous disease states. The important question of whether and how fibrosis contributes to SS pathogenesis is currently intensely debated. Here, we collect the recent findings on EMT-dependent fibrosis in SS SGs and explore clinical evidence of multi-organ fibrosis in SS to highlight potential avenues for therapeutic investigation.

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Feature tracking cardiac magnetic resonance imaging to assess cardiac manifestations of systemic diseases

et al. 2023

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Feature-tracking cardiac magnetic resonance (FT-CMR), with the ability to quantify myocardial deformation, has a unique role in the evaluation of subclinical myocardial abnormalities. This review aimed to evaluate the clinical use of cardiac FT-CMR-based myocardial strain in patients with various systemic diseases with cardiac involvement, such as hypertension, diabetes, cancer-therapy-related toxicities, amyloidosis, systemic scleroderma, myopathies, rheumatoid arthritis, thalassemia major, and coronavirus disease 2019 (COVID-19). We concluded that FT-CMR-derived strain can improve the accuracy of risk stratification and predict cardiac outcomes in patients with systemic diseases prior to symptomatic cardiac dysfunction. Furthermore, FT-CMR is particularly useful for patients with diseases or conditions which are associated with subtle myocardial dysfunction that may not be accurately detected with traditional methods. Compared to patients with cardiovascular diseases, patients with systemic diseases are less likely to undergo regular cardiovascular imaging to detect cardiac defects, whereas cardiac involvement in these patients can lead to major adverse outcomes; hence, the importance of cardiac imaging modalities might be underestimated in this group of patients. In this review, we gathered currently available data on the newly introduced role of FT-CMR in the diagnosis and prognosis of various systemic conditions. Further research is needed to define reference values and establish the role of this sensitive imaging modality, as a robust marker in predicting outcomes across a wide spectrum of patients.

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Asymptomatic myocardial dysfunction was revealed by feature tracking cardiac magnetic resonance imaging in patients with primary Sjögren’s syndrome

Cited by 7 publications

References 35 publications

Comorbidities in the UK Primary Sjögren’s Syndrome Registry

Comorbidities in the UK Primary Sjögren’s Syndrome Registry

Sjögren’s Syndrome-Related Organs Fibrosis: Hypotheses and Realities

Feature tracking cardiac magnetic resonance imaging to assess cardiac manifestations of systemic diseases

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