Nicolò Schicchi1, Gianluca Valeri2, Gianluca Moroncini3,4, Giacomo Agliata5, Luca Salvolini6, Armando Gabrielli3,4, Andrea Giovagnoni7. 1. Radiologia Pediatrica e Specialistica, Azienda Ospedaliero Universitaria, Ospedali Riuniti di Ancona, Via Conca 71, 60126, Torrette, Ancona, Italy. schicchi.n@alice.it. 2. Clinica di Radiologia, d'Urgenza e dell'Area Oncologica, Ospedali Riuniti Ancona, Ancona, Italy. 3. Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy. 4. Clinica Medica, Ospedali Riuniti Ancona, Ancona, Italy. 5. Scuola di Specializzazione in Radiodiagnostica, Università Politecnica delle Marche, Ancona, Italy. 6. Clinica di Radiologia, d'Urgenza e dell'Area Oncologica, Azienda Ospedaliero Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy. 7. Radiologia Pediatrica e Specialistica, Azienda Ospedaliero Universitaria, Ospedali Riuniti di Ancona, Via Conca 71, 60126, Torrette, Ancona, Italy.
Abstract
PURPOSE: The authors investigated whether contrast-enhanced cardiovascular magnetic resonance (CMR) imaging may be used to detect early cardiac involvement in patients with systemic sclerosis (SSc). MATERIALS AND METHODS: Twenty-six SSc patients (nine with diffuse cutaneous SSc and 17 with limited cutaneous SSc) and 13 sex- and age-matched healthy controls (HC) were studied. Contrast-enhanced CMR allowed the analysis of first-pass images (areas of hypo-enhancement indicating perfusion defects) and delayed images (persistent hyper-enhancement indicating fibrosis). Clinical variables including disease duration and presence of major visceral complications of SSc were investigated in each patient. RESULTS: Perfusion defects were detected in 53.8 % of SSc patients but in none of the HC. Perfusion abnormalities were detected in 28.6 % of SSc patients with disease duration less than 2 years and in 29.2 % of asymptomatic SSc patients. Delayed contrast enhancement was present in 25 % of SSc patients but not in HC. All patients with delayed contrast enhancement showed first-pass hypoperfusion. Right ventricular wall thickness was significantly increased in all SSc patients when compared to HC (p < 0.001); a similar trend was observed when SSc patients without pulmonary arterial hypertension were analysed (p < 0.04). A trend to lower end-diastolic and end-systolic right ventricular volumes in SSc versus HC was observed (p < 0.05 and p < 0.04, respectively). CONCLUSIONS: Myocardial hypoperfusion is common in SSc and occurs early in the course of the disease. Co-localisation of perfusion defects and delayed contrast enhancement indicative of fibrosis suggests that myocardial hypoxia may play a role in the pathogenesis of myocardial fibrosis.
PURPOSE: The authors investigated whether contrast-enhanced cardiovascular magnetic resonance (CMR) imaging may be used to detect early cardiac involvement in patients with systemic sclerosis (SSc). MATERIALS AND METHODS: Twenty-six SSc patients (nine with diffuse cutaneous SSc and 17 with limited cutaneous SSc) and 13 sex- and age-matched healthy controls (HC) were studied. Contrast-enhanced CMR allowed the analysis of first-pass images (areas of hypo-enhancement indicating perfusion defects) and delayed images (persistent hyper-enhancement indicating fibrosis). Clinical variables including disease duration and presence of major visceral complications of SSc were investigated in each patient. RESULTS: Perfusion defects were detected in 53.8 % of SSc patients but in none of the HC. Perfusion abnormalities were detected in 28.6 % of SSc patients with disease duration less than 2 years and in 29.2 % of asymptomatic SSc patients. Delayed contrast enhancement was present in 25 % of SSc patients but not in HC. All patients with delayed contrast enhancement showed first-pass hypoperfusion. Right ventricular wall thickness was significantly increased in all SSc patients when compared to HC (p < 0.001); a similar trend was observed when SSc patients without pulmonary arterial hypertension were analysed (p < 0.04). A trend to lower end-diastolic and end-systolic right ventricular volumes in SSc versus HC was observed (p < 0.05 and p < 0.04, respectively). CONCLUSIONS:Myocardial hypoperfusion is common in SSc and occurs early in the course of the disease. Co-localisation of perfusion defects and delayed contrast enhancement indicative of fibrosis suggests that myocardial hypoxia may play a role in the pathogenesis of myocardial fibrosis.
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