Diastolic Function Assessment of Left and Right Ventricles by MRI in Systemic Sclerosis Patients

Abstract

Background Heart involvement is frequent although often clinically silent in systemic sclerosis (SSc) patients. Early identification of cardiac involvement can be improved by noninvasive methods such as MRI, in addition to transthoracic echocardiography (TTE). Purpose To assess the ability of phase‐contrast (PC)‐MRI to detect subclinical left (LV) and right (RV) ventricular diastolic dysfunction in SSc patients. Study Type Prospective. Population Thirty‐five consecutive SSc patients (49 ± 14 years) and 35 sex‐ and age‐matched healthy controls (48.6 ± 13.5 years) who underwent TTE and MRI in the same week. Field Strength/Sequence 5 T/PC‐MRI using a breath‐hold velocity‐encoded gradient echo sequence. Assessment LV TTE (E/E′) and LV and RV PC‐MRI indices of diastolic function (LV early and late transmitral [EM, EfM, AM, AfM] and RV transtricuspid [ET, EfT, AT, AfT] peak filling flow velocities and flow rates, as well as LV [EM'] and RV [ET'] peak longitudinal myocardial velocities during diastole) were measured. Statistical Tests Two‐tailed t‐test, Wilcoxon test, or Fischer test for comparison of variables between SSc and healthy control groups; sensitivity, specificity, receiver‐operating‐characteristic (ROC) area under the curve (AUC) to assess discriminative ability of variables. A P‐value <0.05 was considered statistically significant. Results TTE LV E/E′ and MRI EM/EM' and ET/ET' were significantly higher in SSc patients than in controls (8.27 ± 1.25 vs. 6.70 ± 1.66; 9.43 ± 2.7 vs. 6.51 ± 1.50; 6.51 [4.70–10.40] vs. 4.13 [3.22–5.75], respectively) and separated SSc patients and healthy controls with good sensitivity (68%, 71%, and 80%), specificity (85%, 94%, and 62%), and AUC (0.787, 0.807, and 0.765). LV EfM was significantly higher in SSc patients than in controls (347.1 ± 113.7 vs. 284.7 ± 94.6) as RVAfT (277 [231–355] vs. 220 [154–253] mL/sec) with impaired relaxation pattern (EfT/AfT, 0.95 [0.87–1.21] vs. 1.12 [0.93–1.47]). Data Conclusion MRI was able to detect LV and RV diastolic dysfunction in SSc patients with good accuracy in the absence of LV systolic dysfunction at echocardiography. Use of MRI can allow to better assess the early impact of myocardial fibrosis related to SSc. Level of Evidence 1 Technical Efficacy Stage 2

Editorial for “Diastolic Function Assessment of Left and Right Ventricles by MRI in Systemic Sclerosis Patients”

“…7 The article by Mousseaux specifically evaluated the diastolic function of the right and left ventricles by cardiac MRI in SSc patients. 8 Beyond the traditional evaluation of heart structure, function, myocardium perfusion, and delayed contrast enhancement abnormalities, the authors used the phase-contrast technique to measure blood flow through the valves and myocardial dislocation at the annulus level to evaluate the diastolic function of the right and left ventricles. Diastolic dysfunction was seen in a large proportion of SSc patients, while very few had systolic dysfunction.…”

“…The results shown by Mousseaux indicate that phasecontrast imaging may differentiate SSc patients from controls regarding early cardiac involvement. 8 It remains to be defined if the abnormalities identified by MRI can predict the clinical outcomes of SSc patients and distinguish patients who will develop more or less severe disease over time. Future studies should define the best MRI techniques, parameters, and threshold values to identify SSc patients with clinically significant heart involvement and guide the therapeutic approach.…”