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Updated: Sep 16, 2025
Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
Published on: June 16, 2020
Thermographic abnormalities associate with electrocardiogram/echocardiographic changes and mortality in systemic
Maria Jose Villar1,2, Stefano Di Donato3,4,5, Maria Francisca Bozan1,6
1Department of Rheumatology, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Salford, UK.
Insights
Thermographic abnormalities in systemic sclerosis (SSc) correlate with cardiac issues and higher mortality. Detecting these thermographic changes may aid in identifying at-risk SSc patients for earlier intervention.
Area of Science:
- Rheumatology
- Cardiology
- Medical Imaging
Background:
- Cardiac involvement is a significant cause of mortality in systemic sclerosis (SSc).
- Early detection of cardiac abnormalities in SSc remains challenging.
- Thermography offers a potential non-invasive method to assess physiological changes.
Purpose of the Study:
- To investigate the association between thermographic abnormalities and cardiac involvement in SSc patients.
- To determine if thermographic findings correlate with electrocardiogram (ECG) and transthoracic echocardiography (TTE) results.
- To explore the relationship between thermographic patterns and patient mortality.
Main Methods:
- Retrospective analysis of 266 SSc patients from 2015-2023.
- Evaluation of thermographic data (baseline distal-dorsal difference [DDD] and rewarming impairment) alongside ECG and TTE findings.
- Logistic regression and Kaplan-Meier analyses to assess associations and survival.
Main Results:
- 83% of patients exhibited baseline DDD, and 58% had severe rewarming impairment.
- Baseline DDD was significantly associated with both ECG and TTE abnormalities.
- Increased mortality risk was linked to baseline DDD, male sex, older age, and cardiovascular comorbidities.
Conclusions:
- Thermographic abnormalities, specifically baseline DDD, are associated with cardiac involvement in SSc.
- Thermographic findings correlate with ECG and TTE-detected cardiac abnormalities.
- Thermographic impairment in SSc patients predicts increased mortality risk.
Objectives:
Cardiac involvement is common in SSc and is associated with high mortality, yet is challenging to detect. Our aim was to investigate relationships between cardiac involvement, as assessed by ECG and transthoracic echocardiography (TTE), and thermographic abnormalities.
Methods:
A retrospective (2015-2023) study of SSc patients attending a UK referral centre. Relevant patient characteristic/demographic data were collected. Logistic regression models were used to evaluate the association between thermographic impairment and ECG/TTE abnormalities. Thermography data were categorized by the presence/absence of 'cold fingers' at baseline [defined as one or more distal digits being >1°C colder than the dorsum-a distal-dorsal difference (DDD)]; and impairment with rewarming: 'mild', 'moderate', 'severe'. Kaplan-Meier analysis described differences in survival based on thermographic abnormalities.
Results:
We included 266 patients (84% female, mean age 57 years). Cardiac abnormalities (≥1) were identified in approximately one-third by ECG (39%) and TTE (34%). Baseline DDDs were observed in 83% and severe thermographic impairment of rewarming in 58% of patients. Baseline DDDs were associated with ECG [odds ratio (OR) 1.18, P = 0.047] and TTE (OR 1.19, P = 0.008) in univariable analysis, with stronger associations in multivariable analysis for ECG (OR 2.36, P = 0.073) and TTE (OR 9.08, P = 0.05). Cox Proportional Hazard regression analysis revealed higher mortality risk in patients with baseline DDD [hazard ratio (HR) 6.04], male sex (HR 2.86), older age (HR 1.06) and cardiovascular comorbidities (HR 3.73). Baseline DDD was associated with significantly shorter survival (χ2d 4.04, P = 0.047).
Conclusions:
Thermographic abnormalities were associated with cardiac abnormalities and increased mortality in SSc patients.
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