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

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 patients (75%). 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 patients (31%) and myocardial delayed contrast enhancement was detected in 11/52 patients (21%). No perfusion defects at rest were found. Patients with limited SSc had similar MRI abnormalities to patients with diffuse SSc. Seven of 40 patients (17%) without pulmonary arterial hypertension had RV dilatation.Conclusions:This study shows that MRI is a reliable and sensitive technique for diagnosing heart involvement in SSc and for analysing its mechanisms, including its inflammatory, microvascular and fibrotic components. Compared with 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 the prognosis and treatment strategy.

Hemodynamic Predictors of Survival in Scleroderma-related Pulmonary Arterial Hypertension

“…Age-related changes in cardiac responses to high pressure loads (20) may explain some of the apparent differences in RV contractility between IPAH and SSc-PAH, but direct myocardial involvement from SSc due to microvascular disease or fibrosis may also be a contributing factor. A high prevalence of early RV dysfunction has been observed in patients with SSc without PAH as determined by endomyocardial biopsy (23), magnetic resonance imaging (24)(25)(26)(27), and tissue-Doppler echocardiography (28)(29)(30)(31)(32), although the presence of PH induced by exercise was evidenced in one of the studies (29).…”

Pulmonary hypertension in systemic sclerosis: different phenotypes

“…Recent advances in cardiac imaging, such as magnetic resonance imaging (MRI), have shown that a majority of patients have at least one abnormality on cardiac MRI [33]. We have previously shown that one third of patients have diastolic dysfunction and around 21% have myocardial delayed-contrast enhancement suggestive of myocardial fibrosis [33].…”

Systemic sclerosis – diagnostic and therapeutic recommendations of the Polish Dermatological Society. Part 1: diagnosis and monitoring

“…Bardzo pomocne jest oznaczanie stężenia NT-proBNP, ponieważ stwierdzono korelację między jego wartościami a PAP, oraz wykonanie testu 6-minutowego marszu [49]. Obecnie coraz częściej rekomenduje się badanie serca metodą rezonansu magnetycznego (magnetic resonance imaging -MRI) [50].…”

“…Highly beneficial examinations also include NTproBNP testing, because of a correlation between NT-proBNP and the PAP value, and 6-minute walking test [49]. Cardiac examination by magnetic resonance imaging (MRI) is increasingly recommended nowadays [50]. wykonania obliczenia należy skorzystać z kalkulatora dostępnego na stronie http://detect-pah.com/ [42,43].…”