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Digital Ulcers and Ventricular Arrhythmias as Red Flags to Predict Replacement Myocardial Fibrosis in Systemic
Luna Gargani1, Cosimo Bruni2, Giancarlo Todiere3
1Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy.
Insights
Systemic sclerosis patients with digital ulcers or ventricular arrhythmias are more likely to have myocardial fibrosis. These findings help identify SSc patients who may benefit from advanced cardiac magnetic resonance imaging.
Area of Science:
- Cardiology
- Rheumatology
- Medical Imaging
Background:
- Cardiac involvement is a significant prognostic factor in systemic sclerosis (SSc).
- Echocardiography is limited in detecting myocardial fibrosis, a key indicator of cardiac damage.
- Late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) is the gold standard for fibrosis assessment but has limited availability.
Purpose of the Study:
- To identify clinical and instrumental predictors of LGE-CMR findings in SSc patients.
- To improve patient selection for advanced CMR imaging.
- To better understand cardiac involvement in SSc.
Main Methods:
- 344 SSc patients underwent echocardiography and LGE-CMR.
- 189 patients also had 24-hour ECG Holter monitoring.
- Analysis focused on identifying predictors of myocardial fibrosis.
Main Results:
- 25.1% of SSc patients showed replacement myocardial fibrosis on LGE-CMR.
- History of digital ulcers (OR 2.188) and ventricular arrhythmias (OR 3.086) were independent predictors of fibrosis.
- These factors indicate subclinical cardiac involvement.
Conclusions:
- CMR can detect frequent clinical and subclinical cardiac involvement in SSc.
- Digital ulcers and ventricular arrhythmias are key indicators for potential myocardial fibrosis.
- Shared vascular dysfunction may link peripheral and cardiac complications in SSc.
Background:
Cardiac involvement in systemic sclerosis (SSc) affects the prognosis of the disease. Echocardiography is the first line imaging tool to detect cardiac involvement, but it is not able to routinely detect myocardial fibrosis. Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) is the gold standard for replacement myocardial fibrosis assessment, but its availability is currently limited.
Aim:
We aimed to assess the clinical and instrumental parameters that would be useful for predicting the presence of LGE-CMR, to achieve a better selection of patients with SSc that could benefit from third-level CMR imaging.
Methods:
344 SSc patients underwent a comprehensive echocardiogram and LGE-CMR on the same day; for 189 patients, a 24 h ECG Holter monitoring was available.
Results:
CMR showed non-junctional replacement myocardial fibrosis via LGE in 25.1% patients. A history of digital ulcers (OR 2.188; 95% C.I. 1.069-4.481) and ventricular arrhythmias at ECG Holter monitoring (OR 3.086; 95% C.I. 1.191-7.998) were independent predictors of replacement myocardial fibrosis.
Conclusions:
CMR can detect patterns of clinical and subclinical cardiac involvement, which are frequent in SSc. A history of digital ulcers and evidence of ventricular arrhythmias at ECG Holter monitoring are red flags for the presence of replacement myocardial fibrosis in CMR. The association between digital ulcers and myocardial fibrosis suggests that a similar pathological substrate of abnormal vascular function may underlie peripheral vascular and cardiac complications.
