Current advances in cardiac magnetic resonance imaging in systemic sclerosis

Systemic sclerosis (SSc) is a systemic autoimmune disorder characterized by inflammation, fibroproliferative vasculopathy, and progressive fibrosis. Cardiac involvement is common in SSc and may affect the myocardium, pericardium, heart valves, conduction system, as well as coronary arteries. However, it remains asymptomatic for a long time, which leads to delayed diagnosis and poor prognosis. Accurate and early detection of cardiac abnormalities may warrant a better outcome in SSc. Recent advances in cardiac magnetic resonance imaging (CMR) improved the non-invasive evaluation of heart morphology and function. CMR can accurately identify both left and right ventricle dysfunction, which has a significant clinical and prognosis impact on SSc patients. In terms of myocardial structural alterations, CMR has remarkable diagnosis accuracy in identifying the presence and extent of myocardial fibrosis. When it comes to pulmonary arterial hypertension assessment, emerging data endorse the usefulness of CMR for the non-invasive quantification of it. Two-dimensional and time-resolved three-dimensional phase-contrast velocity-encoded CMR has become promising techniques for the assessment of pulmonary artery flow and stiffness measurements. Furthermore, CMR provides valuable prognostic information, both at the time of diagnosis and during follow-up in SSc patients with pulmonary arterial hypertension. The purpose of this review is to provide an overview of the latest findings in advanced cardiovascular imaging in patients with SSc.