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Heart involvement in systemic sclerosis: an ultrasonic tissue characterisation study
C Ferri1, V Di Bello, A Martini
1Department of Internal Medicine, University of Pisa, Italy.
Insights
Systemic sclerosis (SSc) patients show early preclinical heart changes detected by ultrasonic videodensitometry. This non-invasive method identifies myocardial alterations, potentially predicting future cardiac events in SSc patients.
Area of Science:
- Cardiology
- Rheumatology
- Medical Imaging
Background:
- Systemic sclerosis (SSc) significantly impacts prognosis, with symptomatic heart involvement indicating poor outcomes.
- Autopsy reveals high rates of myocardial fibrosis in SSc patients, yet clinical detection of heart disease is lower.
- A discrepancy exists between clinical findings and autopsy results regarding myocardial fibrosis in SSc.
Purpose of the Study:
- To detect preclinical myocardial alterations in systemic sclerosis (SSc) patients using ultrasonic videodensitometric analysis.
- To investigate early, subclinical cardiac changes in SSc patients before overt ventricular dysfunction appears.
Main Methods:
- Thirty-five SSc patients with normal ventricular function and 25 healthy controls underwent echocardiography.
- Quantitative texture analysis of echocardiographic images was performed, calculating the cyclic variation index (CVI).
- Exclusion criteria included arterial hypertension, renal involvement, and diabetes; all patients had negative maximal exercise stress tests.
Main Results:
- SSc patients exhibited significantly lower cyclic variation index (CVI) values compared to controls in both the septum and posterior wall (p < 0.0001).
- Eighty-eight percent of SSc patients showed changes in cyclic echo amplitude, suggesting myocardial fibrosis.
- Left ventricular mass, blood pressure, and systolic/diastolic functions were comparable between SSc patients and controls.
Conclusions:
- Ultrasonic videodensitometric analysis is a feasible, non-invasive method for detecting early myocardial changes in SSc patients.
- These early changes may be linked to myocardial fibrosis and microcirculatory abnormalities.
- Further research is needed to explore the progression of these changes towards ventricular dysfunction and their association with cardiac sudden death in SSc.
Background:
Clinicoepidemiological findings indicate that symptomatic heart involvement in patients with systemic sclerosis (SSc) predicts a very poor prognosis. At necropsy studies, SSc heart involvement without significant coronary lesions is characterised by patchy myocyte necrosis and contraction band necrosis with collagen replacement leading to myocardial fibrosis. There is a discrepancy between the frequency of clinically evident myocardial disease (25%) and autoptical myocardial fibrosis (81%).
Objective:
The aim of this study was to detect preclinical myocardial alterations in SSc patients by ultrasonic videodensitometric analysis.
Methods:
Thirty five SSc patients (three male, aged 48.6 (11) SD years, range 22-65) with normal ventricular function and 25 age and sex matched healthy controls were studied. All patients had a negative maximal exercise stress; in all cases arterial hypertension, renal involvement, and diabetes were excluded. Echocardiographic images were digitised by a real time videodigitiser (Tomtec Imaging Systems). Quantitative texture analysis was performed on data from the septum and the posterior wall, obtaining mean gray level histogram (MGL) at both end-diastole (d) and end-systole (s). The cyclic variation index (CVI), was calculated according to the formula ((MGLd-MGLs)/MGLd) x 100. Left ventricular mass (LVM), body surface corrected, was calculated according to Penn convention.
Results:
Comparable systolic and diastolic blood pressure, LVM, diastolic and systolic function were recorded in both SSc patients and controls. In contrast, in SSc patients the CVI, which is the expression of the intrinsic myocardial structural function, was significantly lower than in controls (septum: -18 (28)% v 35 (10)%, p < 0.0001; and posterior wall: -13 (32)% v 50 (20)%, p < 0.0001). Changes in cyclic echo amplitude, probably related to myocardial fibrosis, were detected in the large majority of SSc patients (88%).
Conclusions:
Ultrasonic videodensitometric analysis represents a non-invasive, feasible method that can detect early myocardial changes in SSc patients, which could be related to both fibrosis and microcirculatory abnormalities. Their potential evolution towards ventricular dysfunction and their link with cardiac sudden death, because of severe conduction system or rhythm disturbances, should be further investigated.