P926Cardiac involvement in systemic sclerosis: the added value of magnetic resonance imaging.


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Abstract

Purpose: Cardiac involvement in systemic sclerosis (SSc) has high prognostic relevance. The pathological hallmark is myocardial fibrosis that has been reported in >50% of cases in necropsy. Echocardiography is the routine imaging tool to detect cardiac involvement, but it is not accurate for myocardial fibrosis. Cardiovascular magnetic resonance (CMR) might be proposed to assess myocardial fibrosis (by delayed gadolinium enhancement, DE_CMR) and myocardial oedema (by T2-weighted images, T2_CMR). Our aim was to evaluate the added value of CMR to echocardiography in SSc patients.Methods: After a thorough clinical characterization, 53 SSc pts (age=52±14, 95% females, 34% diffuse form) underwent on the same day a comprehensive ecocolorDoppler, including tissue Doppler imaging (TDI), and CMR.Results: Echocardiography showed normal systolic function (ejection fraction=64±6%) and wall motion score index (=1) in 100% pts, whereas DE_CMR showed a pattern of non-ischaemic myocardial fibrosis in 12/53 (23%) pts. In 2/53 (4%) pts, T2_CMR showed myocardial oedema, that resolved after steroid therapy. Among clinical (age, duration of disease, skin and activity scores), echocardiographic (indexed left atrium and left ventricular volumes, right atrium and ventricular dimensions, 2D 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 myocardial fibrosis at multivariate analysis (HR 1.8; 95% C.I. 1.1-3.1).Conclusions: Subclinical cardiac involvement is relatively frequent in SSc. CMR can detect different patterns of reversible (by T2-weighted images) and irreversible (by DE) cardiac involvement. Elevated E/E' at echocardiography may raise the suspicion of myocardial fibrosis.

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