Related Experiment Video
Updated: Jun 10, 2026

Vasodilation of Isolated Vessels and the Isolation of the Extracellular Matrix of Tight-skin Mice
Published on: March 24, 2017
Primary systemic sclerosis heart involvement: A systematic literature review and preliminary data-driven,
Cosimo Bruni1, Maya H Buch2,3, Daniel E Furst1,4
1Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy.
Insights
A new expert consensus definition for primary heart involvement in systemic sclerosis was developed and validated. This definition aims to improve clinical research understanding of cardiac abnormalities in systemic sclerosis patients.
Area of Science:
- Rheumatology and Cardiology
- Systemic Sclerosis Research
- Cardiac Manifestations
Background:
- Primary heart involvement in systemic sclerosis leads to significant cardiac abnormalities and mortality.
- Lack of a clear definition hinders clinical research and understanding of cardiac involvement in systemic sclerosis.
Purpose of the Study:
- To establish an expert consensus definition for primary heart involvement in systemic sclerosis.
- To facilitate focused clinical research on cardiac issues in systemic sclerosis.
Main Methods:
- Systematic literature review on cardiac involvement in systemic sclerosis.
- Nominal group technique employed by an international, multi-disciplinary task force.
- Validation using 16 clinical cases for face validity, feasibility, reliability, and criterion validity.
Main Results:
- A consensus definition was created with 100% agreement on face validity.
- Moderate inter-rater agreement (mKappa = 0.56) and good intra-rater agreement (mKappa = 0.77) were observed.
- Criterion validity demonstrated 78% correctness against a gold standard.
Conclusions:
- A preliminary, consensus-based definition for primary heart involvement in systemic sclerosis has been established.
- This definition has undergone partial validation and is intended for future clinical research applications.
Introduction:
Primary heart involvement in systemic sclerosis may cause morpho-functional and electrical cardiac abnormalities and is a common cause of death. The absence of a clear definition of primary heart involvement in systemic sclerosis limits our understanding and ability to focus on clinical research. We aimed to create an expert consensus definition for primary heart involvement in systemic sclerosis.
Methods:
A systematic literature review of cardiac involvement and manifestations in systemic sclerosis was conducted to inform an international and multi-disciplinary task force. In addition, the nominal group technique was used to derive a definition that was then subject to voting. A total of 16 clinical cases were evaluated to test face validity, feasibility, reliability and criterion validity of the newly created definition.
Results:
In total, 171 publications met eligibility criteria. Using the nominal group technique, experts added their opinion, provided statements to consider and ranked them to create the consensus definition, which received 100% agreement on face validity. A median 60(5-300) seconds was taken for the feasibility on a single case. Inter-rater agreement was moderate (mKappa (95% CI) = 0.56 (0.46-1.00) for the first round and 0.55 (0.44-1.00) for the second round) and intra-rater agreement was good (mKappa (95% CI) = 0.77 (0.47-1.00)). Criterion validity showed a 78 (73-84)% correctness versus gold standard.
Conclusion:
A preliminary primary heart involvement in systemic sclerosis consensus-based definition was created and partially validated, for use in future clinical research.
Related Concept Videos
Pathophysiology of Heart Failure
Rheumatic Heart Disease I: Introduction
Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
Heart Failure I: Introduction
Heart Failure II: Pathophysiology
Heart Failure IV: Classification and Diagnostic Evaluation

