Imaging Modalities Related to Cardiac Involvement in Systemic Sclerosis

Area of Science:

• Rheumatology
• Cardiology
• Medical Imaging

Background:

• Systemic sclerosis (SSc) is a severe rheumatic disease with high mortality, primarily due to organ fibrosis.
• Cardiac involvement is common in SSc but often overlooked, preceding diagnosis and contributing to mortality.
• Early detection of cardiac issues in SSc is crucial for management and prognosis.

Purpose of the Study:

• To review the role of imaging biomarkers, particularly cardiac magnetic resonance (CMR), in detecting early cardiac involvement in Systemic Sclerosis.
• To highlight the potential of CMR in identifying myocardial inflammation, fibrosis, and coronary microvascular disease before functional decline.

Main Methods:

• Review of current literature on imaging modalities for cardiac assessment in SSc.
• Focus on echocardiography (including strain imaging) and cardiac magnetic resonance (CMR) capabilities.
• Discussion of CMR's unique ability for simultaneous functional and tissue characterization.

Main Results:

• Echocardiography provides functional data and assesses pulmonary artery pressure.
• Strain echocardiography and CMR feature tracking detect early systolic dysfunction.
• CMR is uniquely capable of detecting early myocardial inflammation, replacement, diffuse fibrosis, and coronary microvascular disease.

Conclusions:

• Cardiac involvement in SSc is frequent and potentially precedes diagnosis.
• CMR offers superior potential for early detection of subclinical cardiac abnormalities in SSc.
• Further multicenter studies are needed to establish CMR's role in SSc guidelines.