Physician global assessments in systemic sclerosis is related to subclinical cardiac involvement

Systemic sclerosis (SSc), is an autoimmune disease that affects multiple organs. Although physician's Global Assessment (PGA) has been proved to be a useful tool in assessing the risk of outcomes in SSc patients, reliable grading criteria for SSc remain lacking. Early cardiac involvement particularly remains a diagnostic challenge.

This study aims to assess the differences of clinical and cardiac magnetic resonance (CMR) in SSc patients with different duration and states, as indicated by PGA, identifying risk factors indicating potential cardiac involvement.

SSc patients aged 18-70 years old without cardiac symptoms were recruited and underwent CMR at 3.0 T. PGA score was used to grade the SSc disease state: mild, the PGA score ranged from 0 to 1; and moderate/severe, the PGA score ranged from 1 to 3. The relationship between PGA and myocardial T1 values was analyzed using Spearman correlation coefficient. The inter-rater agreement in assessing PGA and the agreement between PGA and European Systemic sclerosis study group activity index (EScSG-AI) were evaluated using Kappa analysis. Linear regression analyses were conducted to evaluate the association between PGA and myocardial native T1 values.

Weak correlation was found between myocardial native T1 values and PGA score (r = 0.379, P = 0.002), particularly in SSc patients in moderate/severe disease state (r = 0.336, P = 0.008). Univariate linear regression analysis revealed that PGA was significantly associated with myocardial native T1 value (β, 15.316; 95%CI, 29.699-90.971; P < 0.001). Multivariate regression analysis showed that the association between PGA and myocardial native T1 value remained statistically significant after adjusting age and sex (model 1: β, 14.788; 95% CI, 35.257-94.461; P < 0.001), age, sex and myositis (model 2: β, 61.110; 95% CI, 32.177-90.043; P < 0.001), and age, sex, myositis, disease duration (model 3: β, 63.895; 95% CI 33.281-94.519; P < 0.001).

PGA was associated with myocardial native T1 values in asymptomatic SSc patients, suggesting that PGA might be a useful tool to evaluate subclinical myocardial involvement of SSc. Key Points • The Physician's Global Assessment (PGA) may offer a low-cost, non-invasive method for identifying subclinical myocardial involvement in SSc patients, potentially enhancing screening and disease management. • These findings provide a basis for further longitudinal studies with larger cohorts to validate the role of PGA in predicting cardiac outcomes in SSc.