Update on assessment and management of primary cardiac involvement in systemic sclerosis

Area of Science:

• Cardiology
• Rheumatology
• Medical Imaging

Background:

• Primary cardiac involvement is a frequent and severe complication of systemic sclerosis (SSc).
• SSc can affect all cardiac structures: pericardium, myocardium, endocardium, valves, and conduction system.
• Cardiac disease in SSc is often clinically silent, leading to delayed diagnosis.

Purpose of the Study:

• To review current understanding of cardiac complications in systemic sclerosis.
• To highlight the role of advanced imaging in diagnosing SSc-related heart disease.
• To emphasize the need for systematic assessment and therapeutic strategies.

Main Methods:

• Review of current literature on cardiac involvement in systemic sclerosis.
• Discussion of advanced imaging techniques, including speckle-tracking echocardiography and cardiovascular magnetic resonance (CMR).
• Detailed description of CMR protocols for assessing SSc cardiac disease (function, inflammation, fibrosis).

Main Results:

• Cardiac disease accounts for approximately 25% of SSc-related deaths.
• Advanced imaging modalities reveal abnormalities in the majority of SSc patients.
• CMR can effectively evaluate ventricular function, myocardial edema (T2-W), and fibrosis (late-gadolinium enhancement).

Conclusions:

• Cardiac complications are a major cause of mortality in systemic sclerosis.
• Early detection and characterization of cardiac involvement using advanced imaging are crucial.
• Further systematic studies and guidelines are needed for optimal management of SSc-related cardiac disease.