Nicola Galea1,2, Edoardo Rosato3, Antonietta Gigante3, Cristian Borrazzo4,5, Andrea Fiorelli1, Giovanni Barchetti1, Amelia Chiara Trombetta3, Maria Anna Digiulio3, Marco Francone1, Carlo Catalano1, Iacopo Carbone1. 1. Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy. 2. Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy. 3. Department of Clinical Medicine, Clinical Immunology Unit- Scleroderma Center, Sapienza University of Rome, Rome, Italy. 4. Statistical Unit, Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy. 5. Radiotherapy Unit, Ospedale San Pietro Fatebenefratelli, Rome, Italy.
Abstract
PURPOSE: Cardiac involvement in Systemic Sclerosis (SSc) is increasingly recognized as a mayor cause of morbidity and mortality. The aim of present study is to investigate the early stages of cardiac involvement in SSc by Cardiovascular magnetic resonance (CMR), combining the non-invasive detection of myocardial inflammation and fibrosis using T2 and T1 mapping techniques and the assessment of microcirculatory impairment through perfusion response to cold pressor test (CPT). METHODS: 40 SSc patients (30 females, mean age: 42.1 years) without cardiac symptoms and 10 controls underwent CMR at 1.5 T unit. CMR protocol included: native and contrast-enhanced T1 mapping, T2 mapping, T2-weighted, cineMR and late gadolinium enhancement (LGE) imaging. Microvascular function was evaluated by comparing myocardial blood flow (MBF) on perfusion imaging acquired at rest and after CPT. Native myocardial T1 and T2 relaxation times, extracellular volume fraction (ECV), T2 signal intensity ratio, biventricular volumes and LGE were assessed in each patient. RESULTS: SSc patients had significantly higher mean myocardial T1 (1029±32ms vs. 985±18ms, p<0.01), ECV (30.1±4.3% vs. 26.7±2.4%, p<0.05) and T2 (50.1±2.8ms vs. 47±1.5ms, p<0.01) values compared with controls. No significant differences were found between absolute MBF values at rest and after CPT; whereas lower MBF variation after CPT was observed in SSc patients (+33 ± 14% vs. +44 ± 12%, p<0.01). MBF variation had inverse correlation with native T1 values (r: -0.32, p<0.05), but not with ECV. CONCLUSIONS: Myocardial involvement in SSc at preclinical stage increases native T1, T2 and ECV values, reflecting inflammation and fibrosis, and reduces vasodilatory response to CPT, as expression of microvascular dysfunction.
PURPOSE:Cardiac involvement in Systemic Sclerosis (SSc) is increasingly recognized as a mayor cause of morbidity and mortality. The aim of present study is to investigate the early stages of cardiac involvement in SSc by Cardiovascular magnetic resonance (CMR), combining the non-invasive detection of myocardial inflammation and fibrosis using T2 and T1 mapping techniques and the assessment of microcirculatory impairment through perfusion response to cold pressor test (CPT). METHODS: 40 SSc patients (30 females, mean age: 42.1 years) without cardiac symptoms and 10 controls underwent CMR at 1.5 T unit. CMR protocol included: native and contrast-enhanced T1 mapping, T2 mapping, T2-weighted, cineMR and late gadolinium enhancement (LGE) imaging. Microvascular function was evaluated by comparing myocardial blood flow (MBF) on perfusion imaging acquired at rest and after CPT. Native myocardial T1 and T2 relaxation times, extracellular volume fraction (ECV), T2 signal intensity ratio, biventricular volumes and LGE were assessed in each patient. RESULTS: SSc patients had significantly higher mean myocardial T1 (1029±32ms vs. 985±18ms, p<0.01), ECV (30.1±4.3% vs. 26.7±2.4%, p<0.05) and T2 (50.1±2.8ms vs. 47±1.5ms, p<0.01) values compared with controls. No significant differences were found between absolute MBF values at rest and after CPT; whereas lower MBF variation after CPT was observed in SSc patients (+33 ± 14% vs. +44 ± 12%, p<0.01). MBF variation had inverse correlation with native T1 values (r: -0.32, p<0.05), but not with ECV. CONCLUSIONS: Myocardial involvement in SSc at preclinical stage increases native T1, T2 and ECV values, reflecting inflammation and fibrosis, and reduces vasodilatory response to CPT, as expression of microvascular dysfunction.
Authors: G Valentini; A Della Rossa; S Bombardieri; W Bencivelli; A J Silman; S D'Angelo; M M Cerinic; J F Belch; C M Black; P Bruhlmann; L Czirják; A De Luca; A A Drosos; C Ferri; A Gabrielli; R Giacomelli; G Hayem; M Inanc; N J McHugh; H Nielsen; M Rosada; R Scorza; J Stork; A Sysa; F H van den Hoogen; P J Vlachoyiannopoulos Journal: Ann Rheum Dis Date: 2001-06 Impact factor: 19.103
Authors: Frank van den Hoogen; Dinesh Khanna; Jaap Fransen; Sindhu R Johnson; Murray Baron; Alan Tyndall; Marco Matucci-Cerinic; Raymond P Naden; Thomas A Medsger; Patricia E Carreira; Gabriela Riemekasten; Philip J Clements; Christopher P Denton; Oliver Distler; Yannick Allanore; Daniel E Furst; Armando Gabrielli; Maureen D Mayes; Jacob M van Laar; James R Seibold; Laszlo Czirjak; Virginia D Steen; Murat Inanc; Otylia Kowal-Bielecka; Ulf Müller-Ladner; Gabriele Valentini; Douglas J Veale; Madelon C Vonk; Ulrich A Walker; Lorinda Chung; David H Collier; Mary Ellen Csuka; Barri J Fessler; Serena Guiducci; Ariane Herrick; Vivien M Hsu; Sergio Jimenez; Bashar Kahaleh; Peter A Merkel; Stanislav Sierakowski; Richard M Silver; Robert W Simms; John Varga; Janet E Pope Journal: Arthritis Rheum Date: 2013-10-03
Authors: Matthias G Friedrich; Udo Sechtem; Jeanette Schulz-Menger; Godtfred Holmvang; Pauline Alakija; Leslie T Cooper; James A White; Hassan Abdel-Aty; Matthias Gutberlet; Sanjay Prasad; Anthony Aletras; Jean-Pierre Laissy; Ian Paterson; Neil G Filipchuk; Andreas Kumar; Matthias Pauschinger; Peter Liu Journal: J Am Coll Cardiol Date: 2009-04-28 Impact factor: 24.094
Authors: Daniel R Messroghli; Aleksandra Radjenovic; Sebastian Kozerke; David M Higgins; Mohan U Sivananthan; John P Ridgway Journal: Magn Reson Med Date: 2004-07 Impact factor: 4.668
Authors: Patrick Krumm; Karin A L Mueller; Karin Klingel; Ulrich Kramer; Marius S Horger; Tanja Zitzelsberger; Reinhard Kandolf; Meinrad Gawaz; Konstantin Nikolaou; Bernhard D Klumpp; Joerg C Henes Journal: J Cardiovasc Magn Reson Date: 2016-10-21 Impact factor: 5.364
Authors: Ntobeko A B Ntusi; Stefan K Piechnik; Jane M Francis; Vanessa M Ferreira; Aitzaz B S Rai; Paul M Matthews; Matthew D Robson; James Moon; Paul B Wordsworth; Stefan Neubauer; Theodoros D Karamitsos Journal: J Cardiovasc Magn Reson Date: 2014-03-04 Impact factor: 5.364
Authors: Francisco Vasques-Nóvoa; António Angélico-Gonçalves; José M G Alvarenga; João Nobrega; Rui J Cerqueira; Jennifer Mancio; Adelino F Leite-Moreira; Roberto Roncon-Albuquerque Journal: ESC Heart Fail Date: 2022-02-11