Early myocardial damage and microvascular dysfunction in asymptomatic patients with systemic sclerosis: A cardiovascular magnetic resonance study with cold pressor test

Abstract

Purpose Cardiac involvement in Systemic Sclerosis (SSc) is increasingly recognized as a mayor cause of morbidity and mortality. The aim of present study is to investigate the early stages of cardiac involvement in SSc by Cardiovascular magnetic resonance (CMR), combining the non-invasive detection of myocardial inflammation and fibrosis using T2 and T1 mapping techniques and the assessment of microcirculatory impairment through perfusion response to cold pressor test (CPT). Methods 40 SSc patients (30 females, mean age: 42.1 years) without cardiac symptoms and 10 controls underwent CMR at 1.5 T unit. CMR protocol included: native and contrast-enhanced T1 mapping, T2 mapping, T2-weighted, cineMR and late gadolinium enhancement (LGE) imaging. Microvascular function was evaluated by comparing myocardial blood flow (MBF) on perfusion imaging acquired at rest and after CPT. Native myocardial T1 and T2 relaxation times, extracellular volume fraction (ECV), T2 signal intensity ratio, biventricular volumes and LGE were assessed in each patient. Results SSc patients had significantly higher mean myocardial T1 (1029±32ms vs. 985±18ms, p<0.01), ECV (30.1±4.3% vs. 26.7±2.4%, p<0.05) and T2 (50.1±2.8ms vs. 47±1.5ms, p<0.01) values compared with controls. No significant differences were found between absolute MBF values at rest and after CPT; whereas lower MBF variation after CPT was observed in SSc patients (+33 ± 14% vs. +44 ± 12%, p<0.01). MBF variation had inverse correlation with native T1 values (r: -0.32, p<0.05), but not with ECV. Conclusions Myocardial involvement in SSc at preclinical stage increases native T1, T2 and ECV values, reflecting inflammation and fibrosis, and reduces vasodilatory response to CPT, as expression of microvascular dysfunction.

Respiratory Motion-Registered Isotropic Whole-Heart T2 Mapping in Patients With Acute Non-ischemic Myocardial Injury

“…Therefore, the assessment of institution-specific reference ranges with established scanner- and sequence-specific T 2 values in healthy volunteers are strongly recommended ( 2 ). With scanner- and sequence-specific reference values as a prerequisite, it was demonstrated that T 2 values in studies of specific inflammatory conditions such as myocarditis ( 3 ), systemic sclerosis ( 37 ), and sarcoidosis ( 35 ) can unequivocally be used to identify myocardial injury. Therefore, the significant difference in T 2 relaxation time that was found in patients using the 3D but not the 2D T 2 mapping merits special attention, as this might suggest better sensitivity to detect tissue alterations with the proposed high-resolution motion-registered radial 3D T 2 mapping technique at 1.5T.…”

Utilization of Cardiovascular Magnetic Resonance Imaging for Resumption of Athletic Activities Following COVID-19 Infection: An Expert Consensus Document on Behalf of the American Heart Association Council on Cardiovascular Radiology and Intervention Leadership and Endorsed by the Society for Cardiovascular Magnetic Resonance

“…For T1 mapping, prior COVID-19 studies have used an array of pulse sequences that vary with respect to saturation/inversion pulse design, sampling interval, and fitting algorithm. 48-50,5-80,51,52,61,72,82-84,86,87 Similarly, among the T2 mapping studies reported, different pulse sequences, fitting algorithms, and signal equations have been used to estimate decay curves 48,49,51,52,61,72,76-80,82-87 —each of which is capable of impacting the derived T2. Additionally, as is the case for LGE, variable spatial resolution provides a potential source of data heterogeneity of particular importance to the post-COVID athlete, given that endurance and strength-trained athletes can manifest differential LV remodeling 90,91 and that some studies have reported athletes to manifest increased LV trabeculations 92 (providing a source of partial voxel admixture of LV blood pool and myocardium).…”

Cardiovascular Imaging for Systemic Sclerosis Monitoring and Management

“…Another study found that, in addition to higher ECV, SSc patients also had less myocardial blood flow augmentation (measured by CMR perfusion imaging) when experiencing a cold pressor test (hand immersion in cold water) compared to healthy controls. This muted vasodilatory response was favored to represent microvascular dysfunction in this population ( 63 ). Higher baseline ECV also correlates to risk of cardiovascular events among SSc patients with normal echocardiograms who are monitored over time.…”