Cardiovascular Magnetic Resonance Identifies High-Risk Systemic Sclerosis Patients with Normal Echocardiograms and
George Markousis-Mavrogenis1, Vasiliki-Kalliopi Bournia2, Stylianos Panopoulos2
1Department of Cardiology, Onassis Cardiac Surgery Center, 17674 Athens, Greece.
Insights
Cardiovascular magnetic resonance (CMR) detects myocardial lesions in systemic sclerosis (SSc) patients with normal echocardiograms, aiding diagnosis and prognosis. These lesions predict future cardiac events and mortality.
Area of Science:
- Cardiology
- Radiology
- Systemic Sclerosis Research
Background:
- Acute cardiac events significantly contribute to mortality in systemic sclerosis (SSc).
- Echocardiography may appear normal in SSc patients experiencing acute cardiac events.
- Cardiovascular magnetic resonance (CMR) may offer additional diagnostic and prognostic insights.
Purpose of the Study:
- To evaluate the incremental diagnostic and prognostic value of CMR in diffuse SSc patients with acute cardiac events and normal echocardiograms.
- To identify CMR-derived parameters predictive of cardiac events and mortality in this population.
Main Methods:
- Fifty consecutive diffuse SSc patients with normal echocardiograms underwent 1.5T CMR.
- Patients were assessed for acute cardiac events occurring 3-10 days prior to CMR.
- CMR parameters included ventricular volumes, ejection fractions, mass, T2-signal ratio, early/late gadolinium enhancement (EGE/LGE), T1/T2-mapping, and extracellular volume fraction (ECV).
Main Results:
- No significant differences in ventricular volumes, ejection fractions, or mass were found between groups.
- EGE, LGE, T2-mapping, and native/post-contrast T1-mapping were independent predictors of acute cardiac events.
- LGE, T2-mapping, and native T1-mapping independently predicted a combined endpoint of event occurrence/recurrence or cardiovascular mortality at follow-up.
Conclusions:
- Normal echocardiograms do not exclude myocardial lesions in diffuse SSc patients.
- CMR effectively detects myocardial lesions, particularly in symptomatic SSc patients.
- CMR findings, especially LGE, T2-mapping, and native T1-mapping, have prognostic value for cardiovascular outcomes in SSc.
Background:
Acute cardiac events are a significant contributor to mortality in systemic sclerosis (SSc). However, echocardiographic evaluation may be deceptively normal during an acute presentation. We hypothesized that in diffuse SSc patients presenting with acute cardiac events and a normal echocardiogram, cardiovascular magnetic resonance (CMR) would have incremental diagnostic/prognostic value.
Methods:
50 consecutive diffuse SSc patients with normal echocardiograms were evaluated using a 1.5T system. A total of 27 (63%) had experienced an acute cardiac event three to tendays before CMR evaluation (rhythm disturbances, angina pectoris, shortness of breath). Left/right ventricular (LV/RV) volumes and ejection fractions (EF), as well as LV mass, the T2-signal ratio, early/late gadolinium enhancement (EGE/LGE), native/post-contrast T1-mapping, T2-mapping and extracellular volume fraction (ECV) were compared between the event and no-event groups.
Results:
No differences were identified in LV/RV volumes/EF/mass. In logistic regression analyses, independent predictors of belonging to the event group were EGE (odds ratio (95% CI): 1.55 (1.06-2.26), p = 0.024), LGE (1.81 (1.23-2.67), p = 0.003), T2 mapping (1.20 (1.06-1.36), p = 0.004) and native/post-contrast T1 mapping (1.17 (1.04-1.32), p = 0.007 and 0.86 (0.75-0.98), p = 0.025). At a median follow-up of ~1.2 years, 42% vs. 11% of the event/no-event group respectively reached a combined endpoint of event occurrence/recurrence or cardiovascular mortality. Of the independent predictors resulting from logistic regression analyses, only LGE (hazard ratio (95% CI): 1.20 (1.11-1.30), p < 0.001), T2-mapping (1.07 (1.01-1.14), p = 0.025) and native T1-mapping (1.08 (1.01-1.15), p = 0.017) independently predicted the combined endpoint.
Conclusions:
A normal echocardiogram does not preclude myocardial lesions in diffuse SSc patients, which can be detected by CMR especially in symptomatic patients.
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