Raluca B Dumitru1,2, Lesley-Anne Bissell1,2, Bara Erhayiem3, Graham Fent3, Ananth Kidambi3, Peter Swoboda3, Giuseppina Abignano1,2, Helena Donica4, Agata Burska1,2, John P Greenwood3, John Biglands2, Francesco Del Galdo1,2, Sven Plein3, Maya H Buch1,5,6. 1. Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK. 2. Leeds Biomedical Research Centre, National Institute for Health Research, Leeds, UK. 3. Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. 4. Department of Biochemical Diagnostics, Medical University of Lublin, Lublin, Poland. 5. Centre for Musculoskeletal Research, University of Manchester, Manchester, UK. 6. NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
Abstract
OBJECTIVES: SSc primary heart involvement (SSc-pHI) is a significant cause of mortality. We aimed to characterize and identify predictors of subclinical SSc-pHI using cardiovascular MRI. METHODS: A total of 83 SSc patients with no history of cardiovascular disease or pulmonary arterial hypertension and 44 healthy controls (HCs) underwent 3 Tesla contrast-enhanced cardiovascular MRI, including T1 mapping and quantitative stress perfusion. High-sensitivity troponin I and N-terminal pro-brain natriuretic peptide were also measured. RESULTS: Cardiovascular MRI revealed a lower myocardial perfusion reserve in the SSc patients compared with HCs {median (interquartile range (IQR)] 1.9 (1.6-2.4) vs 3 (2-3.6), P < 0.001}. Late gadolinium enhancement, indicating focal fibrosis, was observed in 17/83 patients but in none of the HCs, with significantly higher extracellular volume (ECV), suggestive of diffuse fibrosis, in SSc vs HC [mean (s.d.) 31 (4) vs 25 (2), P < 0.001]. Presence of late gadolinium enhancement and higher ECV was associated with skin score [odds ratio (OR) = 1.115, P = 0.048; R2 = 0.353, P = 0.004], and ECV and myocardial perfusion reserve was associated with the presence of digital ulcers at multivariate analysis (R2 = 0.353, P < 0.001; R2 = 0.238, P = 0.011). High-sensitivity troponin I was significantly higher in patients with late gadolinium enhancement, and N-terminal pro-brain natriuretic peptide was associated with ECV (P < 0.05). CONCLUSION: Subclinical SSc-pHI is characterized by myocardial microvasculopathy, diffuse and focal myocardial fibrosis but preserved myocardial contractile function. This subclinical phenotype of SSc-pHI was associated with high-sensitivity troponin I, N-terminal pro-brain natriuretic peptide, SSc disease severity and complicated peripheral vasculopathy. These data provide information regarding the underlying pathophysiological processes and provide a basis for identifying individuals at risk of SSc-pHI.
OBJECTIVES: SSc primary heart involvement (SSc-pHI) is a significant cause of mortality. We aimed to characterize and identify predictors of subclinical SSc-pHI using cardiovascular MRI. METHODS: A total of 83 SSc patients with no history of cardiovascular disease or pulmonary arterial hypertension and 44 healthy controls (HCs) underwent 3 Tesla contrast-enhanced cardiovascular MRI, including T1 mapping and quantitative stress perfusion. High-sensitivity troponin I and N-terminal pro-brain natriuretic peptide were also measured. RESULTS: Cardiovascular MRI revealed a lower myocardial perfusion reserve in the SSc patients compared with HCs {median (interquartile range (IQR)] 1.9 (1.6-2.4) vs 3 (2-3.6), P < 0.001}. Late gadolinium enhancement, indicating focal fibrosis, was observed in 17/83 patients but in none of the HCs, with significantly higher extracellular volume (ECV), suggestive of diffuse fibrosis, in SSc vs HC [mean (s.d.) 31 (4) vs 25 (2), P < 0.001]. Presence of late gadolinium enhancement and higher ECV was associated with skin score [odds ratio (OR) = 1.115, P = 0.048; R2 = 0.353, P = 0.004], and ECV and myocardial perfusion reserve was associated with the presence of digital ulcers at multivariate analysis (R2 = 0.353, P < 0.001; R2 = 0.238, P = 0.011). High-sensitivity troponin I was significantly higher in patients with late gadolinium enhancement, and N-terminal pro-brain natriuretic peptide was associated with ECV (P < 0.05). CONCLUSION: Subclinical SSc-pHI is characterized by myocardial microvasculopathy, diffuse and focal myocardial fibrosis but preserved myocardial contractile function. This subclinical phenotype of SSc-pHI was associated with high-sensitivity troponin I, N-terminal pro-brain natriuretic peptide, SSc disease severity and complicated peripheral vasculopathy. These data provide information regarding the underlying pathophysiological processes and provide a basis for identifying individuals at risk of SSc-pHI.
Authors: Sophie I Mavrogeni; Konstantinos Bratis; Georgia Karabela; George Spiliotis; Kees van Wijk; David Hautemann; Johan H C Reiber; Loukia Koutsogeorgopoulou; George Markousis-Mavrogenis; Genovefa Kolovou; Efthymios Stavropoulos Journal: Inflamm Allergy Drug Targets Date: 2015
Authors: George E Tzelepis; Nikolaos L Kelekis; Sotiris C Plastiras; Panayiotis Mitseas; Nikolaos Economopoulos; Christos Kampolis; Elias J Gialafos; Ioannis Moyssakis; Haralampos M Moutsopoulos Journal: Arthritis Rheum Date: 2007-11
Authors: Timothy C Wong; Kayla Piehler; Christopher G Meier; Stephen M Testa; Amanda M Klock; Ali A Aneizi; Jonathan Shakesprere; Peter Kellman; Sanjeev G Shroff; David S Schwartzman; Suresh R Mulukutla; Marc A Simon; Erik B Schelbert Journal: Circulation Date: 2012-07-31 Impact factor: 29.690
Authors: Daniel C Lee; Monique E Hinchcliff; Roberto Sarnari; Madeline M Stark; Jungwha Lee; Kimberly Koloms; Aileen Hoffmann; Mary Carns; Anjali Thakrar; Kathleen Aren; John Varga; Alejandro Aquino; James C Carr; Brandon C Benefield; Sanjiv J Shah Journal: J Scleroderma Relat Disord Date: 2018-04-12
Authors: Darius Dabir; Nicholas Child; Ashwin Kalra; Toby Rogers; Rolf Gebker; Andrew Jabbour; Sven Plein; Chung-Yao Yu; James Otton; Ananth Kidambi; Adam McDiarmid; David Broadbent; David M Higgins; Bernhard Schnackenburg; Lucy Foote; Ciara Cummins; Eike Nagel; Valentina O Puntmann Journal: J Cardiovasc Magn Reson Date: 2014-10-21 Impact factor: 5.364
Authors: Adam K McDiarmid; Peter P Swoboda; Bara Erhayiem; Rosalind E Lancaster; Gemma K Lyall; David A Broadbent; Laura E Dobson; Tarique A Musa; David P Ripley; Pankaj Garg; John P Greenwood; Carrie Ferguson; Sven Plein Journal: Circ Cardiovasc Imaging Date: 2016-04 Impact factor: 7.792
Authors: Alain Lescoat; Susan L Murphy; Yen T Chen; Nadia Vann; Francesco Del Galdo; David Cella; Maya H Buch; Dinesh Khanna Journal: Semin Arthritis Rheum Date: 2021-11-07 Impact factor: 5.431
Authors: Lilia M Sierra-Galan; Mona Bhatia; Angel Leovigildo Alberto-Delgado; Javier Madrazo-Shiordia; Carlos Salcido; Bernardo Santoyo; Eduardo Martinez; Maria Elena Soto Journal: Front Cardiovasc Med Date: 2022-07-13