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Biomarkers in the evaluation of cardiac involvement in systemic sclerosis
Mohamad Fadhli Bin Masri1, Sue-Ann Ng1,2, Calvin Wl Chin3
1Department of Rheumatology and Immunology, Singapore General Hospital, Bukit Merah, Singapore.
Insights
Systemic sclerosis can cause heart damage, with biomarkers like cardiac troponins and IL-6 aiding early detection. Identifying these cardiac biomarkers in systemic sclerosis improves patient outcomes.
Area of Science:
- Cardiology
- Rheumatology
- Immunology
Background:
- Systemic sclerosis is a multisystemic autoimmune disease with significant cardiac involvement, affecting up to 80% of patients.
- Cardiac complications in systemic sclerosis contribute to increased mortality.
- Early identification of cardiac involvement is crucial for managing patient outcomes.
Purpose of the Study:
- To review current biomarkers for diagnosing, prognosing, and predicting primary cardiac involvement in systemic sclerosis.
- To explore novel biomarkers based on the pathophysiology of systemic sclerosis.
- To emphasize the clinical utility of biomarkers for early detection and improved patient management.
Main Methods:
- Literature review of diagnostic and prognostic biomarkers for cardiac involvement in systemic sclerosis.
- Analysis of biomarkers originating from cardiac damage (e.g., troponins) and immune dysregulation (e.g., IL-6).
- Identification of potential new biomarkers informed by current disease understanding.
Main Results:
- Cardiac troponins and proinflammatory cytokines like IL-6 are established biomarkers.
- Biomarkers can indicate direct cardiac damage or reflect the underlying immune process.
- Asymptomatic patients may have high-risk cardiac involvement detectable by biomarkers.
Conclusions:
- Biomarkers are essential for early identification of cardiac involvement in systemic sclerosis, including in asymptomatic individuals.
- Utilizing these biomarkers can lead to timely interventions and better patient prognoses.
- Further research into novel biomarkers holds promise for enhancing the management of cardiac complications in systemic sclerosis.
Abstract:
Systemic sclerosis is a multisystemic disease for which the heart can be affected leading to cardiac complications and mortality. Up to 80% of patients with systemic sclerosis have cardiac involvement with varying levels of severity. Several molecules have been identified that can be used as markers of cardiac involvement. These biomarkers can arise directly from the heart due to cardiac damage from the disease such as cardiac troponins or from the underlying dysregulated immune process itself such as the proinflammatory cytokines including interleukin (IL)-6. This review aims to summarize the evidence on currently known biomarkers that are can be diagnostic, prognostic or predictive of primary cardiac involvement in systemic sclerosis. We also highlight potential new biomarkers based on the current understanding of the disease process. Clinical use of these markers can benefit patients through earlier identification of those with cardiac involvement, many of whom can be asymptomatic in the early stage, with higher risk of complications, with the overall goal to improve outcomes of these affected patients.
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