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Updated: Nov 3, 2025

Ultrasonic Assessment of Myocardial Microstructure
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Predictors of subclinical systemic sclerosis primary heart involvement characterised by microvasculopathy and

Raluca B Dumitru1,2, Lesley-Anne Bissell1,2, Bara Erhayiem3

  • 1Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.

Rheumatology (Oxford, England)
|June 3, 2021
PubMed

Insights

Subclinical heart involvement in SSc patients is common, characterized by reduced heart muscle blood flow and fibrosis. Cardiovascular MRI can identify these changes and predict risks associated with disease severity.

Area of Science:

  • Cardiology
  • Radiology
  • Rheumatology

Background:

  • Systemic sclerosis (SSc) primary heart involvement (SSc-pHI) is a major cause of mortality.
  • Early detection of subclinical SSc-pHI is crucial for risk stratification and management.

Purpose of the Study:

  • To characterize subclinical SSc-pHI using cardiovascular MRI.
  • To identify predictors of subclinical SSc-pHI in SSc patients without prior cardiovascular disease.

Main Methods:

  • 83 SSc patients and 44 healthy controls underwent 3 Tesla contrast-enhanced cardiovascular MRI, including T1 mapping and quantitative stress perfusion.
  • Blood biomarkers including high-sensitivity troponin I and N-terminal pro-brain natriuretic peptide were measured.

Main Results:

  • SSc patients showed significantly lower myocardial perfusion reserve and higher extracellular volume (ECV) compared to controls, indicating microvascular dysfunction and diffuse fibrosis.
  • Late gadolinium enhancement (focal fibrosis) was present in 17% of SSc patients.
  • Higher ECV and impaired perfusion reserve were associated with SSc disease severity (skin score) and digital ulcers.

Conclusions:

  • Subclinical SSc-pHI is characterized by myocardial microvasculopathy and fibrosis, but preserved contractile function.
  • Biomarkers and MRI findings correlate with SSc disease severity and complications.
  • Cardiovascular MRI provides insights into SSc-pHI pathophysiology and aids in identifying at-risk individuals.
Abstract

Keywords:
SSc primary heart involvementcardiovascular magnetic resonancerisk stratification

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