Myocardial Involvement in Systemic Sclerosis: A State-of-the-Art Review of Multimodality Cardiovascular Imaging

Area of Science:

• Cardiology
• Rheumatology
• Autoimmune Diseases

Background:

• Systemic sclerosis (SSc) is an autoimmune disease causing microvascular dysfunction, immune activation, and fibrosis.
• Cardiac involvement in SSc, including myocardial dysfunction and fibrosis, is common but often underrecognized.
• These cardiac issues significantly increase morbidity and mortality in SSc patients.

Purpose of the Study:

• To review current knowledge on myocardial involvement in SSc.
• To provide an overview of cardiovascular imaging techniques for SSc cardiac assessment.
• To highlight the role of imaging in early detection and risk stratification.

Main Methods:

• Literature review focusing on cardiovascular imaging in SSc.
• Evaluation of echocardiography, cardiac magnetic resonance (CMR), nuclear imaging (PET, SPECT), and CT.
• Consideration of advanced techniques like AI, radiomics, and molecular imaging.

Main Results:

• Multimodality cardiovascular imaging is crucial for detecting SSc myocardial involvement.
• Advanced imaging identifies subclinical dysfunction, microvascular impairment, inflammation, and fibrosis.
• An integrated imaging approach enhances diagnosis and risk stratification.

Conclusions:

• Cardiovascular imaging is essential for managing SSc-related heart disease.
• Early detection and comprehensive assessment via imaging improve patient outcomes.
• Integrated imaging strategies are key to better managing cardiac manifestations in SSc.