Clinical and laboratory predictions of myocardial inflammation as detected by cardiac magnetic resonance imaging in patients with systemic sclerosis: A pilot study

Tipparot, Thapanee; Foocharoen, Chingching; Mahakkanukrauh, Ajanee; Suwannaroj, Siraphop; Nanagara, Ratanavadee; Pussadhamma, Burabha; Chaosuwannakit, Narumol

doi:10.1111/1756-185x.13727

Cited by 5 publications

(6 citation statements)

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“…Our results also indicated that an increased CK‐MB level was an independent risk factor for death. CK‐MB is a major indicator of myocardial damage, and our results support the interpretation that cardiac involvement of SSc patients is responsible for this increased risk of death 40 . In addition, some patients with SSc have myositis, which can also increase the level of CK and CK‐MB.…”

Section: Discussionsupporting

confidence: 86%

Clinical features and prognostic factors of systemic sclerosis in Guangxi, China: Retrospective, single‐center study of long‐term survival in 470 patients

Chen¹,

Yang

Pan

et al. 2021

Int J of Rheum Dis

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Objective Systemic sclerosis (SSc) is an autoimmune disease the prevalence of which varies among populations. We analyzed SSc patients from Guangxi to improve the clinical understanding of this disease. Methods Data of 470 SSc patients admitted to our institution from October 1,2012 to January 1,2019 were examined. The characteristics of these patients were analyzed using Kaplan‐Meier survival analysis. Cox proportional‐hazard regression was used to identify prognostic factors. Results The average age was 50.44 ± 12.31 years, 285 patients (60.6%) were women, 2.1% had pneumoconiosis, 58.2% had pulmonary interstitial disease (ILD), 18.7% had pulmonary hypertension (PH), and 3.6% had renal crisis. These patients had diffuse cutaneous systemic sclerosis (dcSSc, 70.2%) or limited cutaneous systemic sclerosis (29.7%), and PH and renal crisis were more common in the dcSSc group. Patients 50 years old or more had greater prevalences of ILD, PH, and musculoskeletal damage, greater positivity of laboratory biomarkers, and increased mortality (all P < .05). Seventy‐four patients (15.7%) died. The non‐survivors were older, had longer disease duration, had higher prevalences of ILD, restrictive ventilation dysfunction, PH, and renal crisis, and had higher levels of creatine kinase myocardial band (CK‐MB), C‐reactive protein, and immunoglobin A (all P < .05). Renal crisis, PH, and high CK‐MB were independent risk factors for death. Conclusions Pneumoconiosis was more common in SSc patients than the general population from this region. Our patients had a 10‐year cumulative survival rate of 74.9%, higher than reported for patients from the US. Renal crisis, PH, and high CK‐MB level were independent risk factors for death.

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Section: Discussionsupporting

confidence: 86%

Clinical features and prognostic factors of systemic sclerosis in Guangxi, China: Retrospective, single‐center study of long‐term survival in 470 patients

Chen¹,

Yang

Pan

et al. 2021

Int J of Rheum Dis

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“…reported the myocardial inflammation according to the Lake Louise Criteria, [ 18 ] from cardiac magnetic resonance imaging during the early onset of SSc (within 4 years of onset), specifically in patients with the dcSSc subset. [ 8 ] The authors also found a combination of myocardial scar and myocardial inflammation from cardiac MRI in the same patients. [ 8 ] Regarding the longer median duration of disease in our SSc patients compared to those in the study by Tipparot et al ., our findings may represent the late complication of myocardial involvement in SSc, which should be associated with myocardial fibrosis rather than myocardial inflammation.…”

Section: Discussionmentioning

confidence: 93%

“…[ 8 ] The authors also found a combination of myocardial scar and myocardial inflammation from cardiac MRI in the same patients. [ 8 ] Regarding the longer median duration of disease in our SSc patients compared to those in the study by Tipparot et al ., our findings may represent the late complication of myocardial involvement in SSc, which should be associated with myocardial fibrosis rather than myocardial inflammation. Although we could not determine whether our patients had myocardial inflammation and/or fibrosis during follow-up or the duration of myocardial fibrosis because cardiac MRI was not a routine investigation in our cohort owing to budget constraints, the findings can provide insight into the natural course of myocardial involvement in SSc.…”

Section: Discussionmentioning

confidence: 94%

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Clinical courses and predictors of left ventricular systolic dysfunction in systemic sclerosis: A cohort study

Werakiat,

Pussadhamma,

Mahakkanukrauh

et al. 2024

Rheumatology and Immunology Research

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Background and Objectives Left ventricular systolic dysfunction (LVSD) is a cardiac involvement that is the leading cause of death among patients with systemic sclerosis (SSc). We aimed to define the clinical course and predictors of LVSD among SSc patients. Methods We conducted a cohort study among adult patients with SSc who were followed up from 2013 to 2020. Semiparametric Cox regression analysis with robust clustering by cohort identification number was used to evaluate the predictors of LVSD. Results Among the 3, 987 person-years, LVSD was defined in 35 of 419 SSc patients for an incidence of 0.88 per 100 person-years. The median duration of the disease was 8.5 (interquartile range (IQR) 4.9–12.9) years. Every 1-point increase in the modified Rodnan skin score (mRSS) and salt and pepper skin were strong predictors of LVSD, with a respective adjusted hazard ratio (HR) of 1.05 and 3.17. During follow-up, 26 cases (74.3%) had unimproved LVSD. The strong predictors of the unimprovement of LVSD were every 1-point increase in mRSS (HR 1.05), every 1 mg increase in prednisolone treatment (HR 1.05), and every 1 U/L increase in creatine kinase (CK) (HR 1.001). Mycophenolate treatment was a protective factor against the unimprovement of LVSD in SSc (HR 0.15). Conclusions LVSD was frequently found in patients with diffuse cutaneous SSc, and in most cases, it remained unimproved during follow-up. High mRSS, steroid use, and high CK levels were predictors of unimproved LVSD, whereas mycophenolate treatment might prevent the progression of LVSD. Steroids should be prescribed with caution in patients with longer disease duration.

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“…Background: Systemic sclerosis (SSc) is an autoimmune connective tissue disease characterized by progressive cutaneous and visceral fibrosis, and disseminated vasculopathy [1]. Due to clinical features, SSc patients may present low muscle mass, which impacts negatively on their daily activities and physical function [2,3]. There are several methods to assess muscle mass such as magnetic resonance imaging (MRI), computed tomography (CT) and dual-energy radiological absorptiometry (DXA).…”

Section: Discussionmentioning

confidence: 99%

Ab0858 pulmonary Arterial Hypertension in Systemic Sclerosis: A National Inpatient Analysis

Sami

Arora

et al. 2023

Scientific Abstracts

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BackgroundPulmonary arterial hypertension (PAH) is a chronic, progressive, and eventually fatal complication of Systemic Sclerosis (SS), affecting the prognosis and quality of life. Risk of PAH in SS is substantially high, and it causes early mortality. Non-specific manifestations of PAH can result in delayed diagnosis and result in poorer outcomes.ObjectivesWe aim to study the prevalence and epidemiology of pulmonary arterial hypertension in SS, and impact of PAH on adult scleroderma hospitalizations in the United States population. We also aim to estimate the effect of PAH in SS on utilization of healthcare resources.MethodsWe utilized the National Inpatient Sample (NIS) to obtain pertinent data. Total adult hospitalizations with primary diagnosis of SS and coexistent comorbidity of PAH were extracted from 2016-2019. We studied the demographic and epidemiological differences as well as mortality outcomes. Healthcare burden was estimated from total hospital charges (THC) and length of stay (LOS). Secondary outcomes including pulmonary embolism, atrial flutter/fibrillation, pneumonia, sepsis, cardiac & renal failure and ventilator requirements were also studied. Statistical analysis was performed on STATA, with linear and logistic regression analyses.ResultsOut of 126,685 adult scleroderma hospitalizations between 2016-19, 21930 (17%) presented with concurrent pulmonary hypertension. Females were significantly more in this group compared to patients with SS without PAH, representing approximately 85% of total admissions. Patients with PAH had a higher mean age (64.85±13.29 vs 62.56±14.51, P 0.000) as well. In terms of racial demographics, there was a significantly higher proportion of African American and significantly less Asians in the study group. Charlson comorbidity index was also higher >3 in the PAH group. PAH was associated with higher adjusted odds ratio (aOR) for mortality (aOR: 1.39, p<0.001), increased LOS (6.64 vs 6.0 days, p<0.001) increased THC ($83813 vs $71016, p <0.001). It was also associated with significantly higher odds for cardiac failure (aOR 3.13) and ventilator requirement (aOR 2.15). Secondary outcomes of kidney failure, Pulmonary embolism, atrial flutter/fibrillation, and pneumonia recorded a significantly higher aOR for patients with PAH. No significant difference in cardiac arrest, sepsis, or respiratory failure was noted.ConclusionPulmonary arterial hypertension in scleroderma is associated with worse overall outcomes in terms of mortality and morbidity, as well as much higher healthcare burden compared to SS without PAH. Also, PAH disproportionately affects African-american & Asian populations. Although advancements have been made in the treatment of PAH in SS, there still remains room for efforts directed towards early diagnosis and management to further improve outcomes for scleroderma patients.Referencesnone.Table 1.Characteristics and Outcomes of adult scleroderma hospitalizations with & without PAHHospitalization Characteristics  and OutcomesSCL without PAHN = 104755SCL with PAHN = 21930P-ValueOdds ratio (OR)Female  87,829 (83.84%)18,730  (85.4%)0.023OR 1.12Age (Mean/SD)62.56/14.5164.85/13.290.000RaceWhite68774 (65.6%)13450 (61.3%)0.000OR 0.82African American15370 (14.6%)4290 (19.5%)0.000OR 1.41Hispanic11735 (11.2%)2505 (11.4%)0.721Asian PI18884 (18%)615 (2.8%)0.000OR 1.57Native American870 (0.8%)194 (0.88%)0.699Total died1410 (6.43%)4250 (4.01%)0.000 (1.39)Length of Stay (LOS) (Mean/SD)6.00 (7.72)6.64 (7.3)0.000Total hospital charges71016838130.000Secondary outcomesOdds ratioP-valueHeart failure3.130.000Pulmonary embolism1.840.000Cerebral infarction0.440.000Atrial Flutter/Atrial Fibrillation1.86/1.560.000/0.000Sepsis0.960.658Pneumonia1.220.000Ventilator2.150.000Acknowledgements:NIL.Disclosure of InterestsNone Declared.

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Clinical and laboratory predictions of myocardial inflammation as detected by cardiac magnetic resonance imaging in patients with systemic sclerosis: A pilot study

Cited by 5 publications

References 30 publications

Clinical features and prognostic factors of systemic sclerosis in Guangxi, China: Retrospective, single‐center study of long‐term survival in 470 patients

Clinical features and prognostic factors of systemic sclerosis in Guangxi, China: Retrospective, single‐center study of long‐term survival in 470 patients

Clinical courses and predictors of left ventricular systolic dysfunction in systemic sclerosis: A cohort study

Ab0858 pulmonary Arterial Hypertension in Systemic Sclerosis: A National Inpatient Analysis

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