Incidental significant arrhythmia in scleroderma associates with cardiac magnetic resonance measure of fibrosis and hs-TnI and NT-proBNP

Abstract

Objectives To screen for significant arrhythmias with an implantable loop recorder (ILR) in patients with SSc and no known cardiovascular disease, and identify associated disease phenotype, blood and cardiovascular magnetic resonance (CMR) biomarkers. Methods Twenty patients with SSc with no history of primary SSc heart disease, traditional cardiovascular disease, diabetes or maximum one traditional cardiovascular risk factor underwent clinical assessment, contrast-enhanced CMR and ILR insertion. Results ILR data were available for 19 patients: 63% female, mean ( s.d. ) age of 53 (12) years, 32% diffuse SSc. Eight patients had significant arrhythmias over 3 years: one complete heart block, two non-sustained ventricular tachycardia [all three dcSSc, two anti-topoisomerase antibodies (Scl70) positive, three interstitial lung disease and two previous digital ulceration] and five atrial arrhythmias of which four were with limited SSc. These required interventions with one permanent pacemaker implantation, four anti-arrhythmic pharmacotherapy, one anticoagulation. Patients with significant arrhythmia had higher baseline high-sensitivity troponin I and N-terminal pro-brain natriuretic peptide [mean difference (95% CI) 117 (−11, 245) and 92 (−30, 215) ng/l, respectively], and CMR-extracellular volume [mean ( s . d .) 32 (2) vs 29 (4)%]. Late gadolinium enhancement was observed in five patients, only one with significant arrhythmia. Conclusion This first ILR study identified potentially life-threatening arrhythmias in asymptomatic SSc patients attributable to a primary SSc heart disease. Disease phenotype, CMR-extracellular volume (indicating diffuse fibrosis) and cardiac biomarkers may identify at-risk patients that would benefit from ILR screening. Future studies can inform a risk model and provide insights into SSc-associated arrhythmia pathogenesis.

Abnormal electrophysiological testing associates with future incidental significant arrhythmia in scleroderma

“…These data reveal that those developing significant arrhythmias over three years were more likely to have (multiple) abnormal EP tests at baseline; with abnormal findings associated with higher serum cardiac biomarkers. This is consistent with our published primary analysis where ILR-detected significant arrhythmia were associated with higher baseline cardiac biomarkers [4]. cardiac biomarkers, and CMR could inform the use of ILR to pre-empt scleroderma heart disease-associated arrhythmias and reduce associated mortality.…”

“…These methods cover a short period of time and may often only demonstrate non-specific, typically benign findings [2,3]. We recently reported the detection of incidental significant arrhythmias in a cohort of patients with SSc using an implantable loop recorder (ILR) [4]. We now report on a secondary analysis to explore if baseline short-term electrophysiological (EP) changes differed in those who developed significant arrhythmias over the study period.…”

“…As previously reported, 19 patients with SSc (free of cardiovascular disease, diabetes and no more than one traditional cardiovascular risk factor) were consented into the ELCASA Of the 19 patients, 63% were female, mean (SD) age of 53 (12) years, and 32% had diffuse SSc (dcSSc). Over three years, eight developed significant arrhythmias; 1 complete heart block (CHB), 2 non-sustained ventricular tachycardia (NSVT) and 5 atrial arrhythmias [4].…”

Percutaneous coronary intervention outcomes in patients with rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis

“…People with SSS are at an increased risk of stroke and this may be further enhanced in a hypercoagulable post-operative period. [23,24] We observed higher odds of post-procedural bleeding in people with SLE. This could be due to thrombocytopenia and platelet dysfunction which are common manifestations of disease activity in SLE.…”

Secreted Frizzled-Related Protein 2 and Extracellular Volume Fraction in Patients with Heart Failure

“…We took special care to avoid partial-volume effects from neighboring tissues or blood pool when delineating the ROI. The following formula was used to calculate ECV fraction [23], in which R1 represents 1/T1, myo pre and myo post represent the pre-and postcontrast myocardial T1 values, respectively, and blood pre and blood post represent the pre-and postcontrast blood pool T1 values, respectively.…”