Multimodality imaging approach in cardiac asymptomatic subjects with systemic sclerosis followed at a tertiary center

To investigate the role of a multimodality imaging approach in detecting subclinical cardiac impairment in systemic sclerosis (SSc) patients.

Between 2017 and 2019 we retrospectively collected data related to 50 consecutive SSc patients who underwent Doppler echocardiography and cardiac magnetic resonance (CMR). The data was compared with 50 controls matched for age, sex and cardiovascular risk predictors.

CMR revealed late gadolinium enhancement (LGE) (30% vs. 8%, p = 0.005), myocardial edema (14% vs. 0%, p = 0.006), and pericardial effusion (18% vs. 4%, p = 0.026) in a significantly higher number of SSc subjects, compared to matched controls. A positive linear correlation has been observed between disease duration and LGE progression from basal to apical left ventricular segments (r = 0.82, p < 0.001). The lower the ejection fraction, the longer the disease duration (r = -0.69, p = 0.004), and the higher the number of LGE segments (r = -0.78, p < 0.001). Multivariate analysis confirmed disease duration as independent predictor of myocardial fibrosis after adjustment for confounders (p < 0.001), as well as the independent association of both LGE and disease duration with impaired left ventricular ejection fraction in SSc subjects (p < 0.001). Doppler echocardiography showed a significantly lower E/A ratio (1.0 ± 0.3 vs. 1.3 ± 0.6, p = 0.002), higher E/e' ratio (10.9 ± 2.5 vs. 6.8 ± 1.1, p < 0.0001) and systolic peak tricuspid regurgitation velocity (2.7 ± 0.6 m/s vs. 2.3 ± 0.5 m/s, p = 0.005) among SSc patients compared to controls. LGE-positive SSc subjects showed a higher E/e' ratio compared to other SSc patients (13.5 ± 2.4 vs. 9.7 ± 1.4, p < 0.0001).

These data confirm the significant prevalence of imaging findings of subtle cardiac impairment in SSc patients, thus suggesting the role of multimodality imaging by Doppler echocardiography and CMR as a potential screening approach in this subset population.