Myocardial fibrosis detected by magnetic resonance in systemic sclerosis patients – Relationship with biochemical and echocardiography parameters

Hromádka, Milan; Seidlerová, Jitka; Suchý, David; Rajdl, Daniel; Lhotský, Jan; Ludvík, Jaroslav; Rokyta, R; Baxa, Jan

doi:10.1016/j.ijcard.2017.08.072

Cited by 42 publications

(26 citation statements)

References 33 publications

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“…Eisenmenger with right-to-left shunt and PAH), the fibrosis in the right ventricle and septum does not fully resemble that of non-congenital PAH, as in idiopathic PAH or PAH associated with connective tissue disorders, such as scleroderma [38,42]. Furthermore, patients with sclerodermas have been shown to have intrinsic myocardial involvement besides PAH-related alterations [29, [43][44][45][46][47][48]. In addition, localized LV fibrosis and infarctions have been shown even in cardiac asymptomatic patients with scleroderma suggesting a more complex fibrosis pattern in this population of PAH [43,44].…”

Section: Late Gadolinium Enhancementmentioning

confidence: 99%

Cardiac Magnetic Resonance Imaging in Pulmonary Arterial Hypertension: Ready for Clinical Practice and Guidelines?

Kjellström

Lindholm

Ostenfeld

2020

Curr Heart Fail Rep

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Purpose of Review Pulmonary arterial hypertension (PAH) is a progressive disease with high mortality. A greater understanding of the physiology and function of the cardiovascular system in PAH will help improve survival. This review covers the latest advances within cardiovascular magnetic resonance imaging (CMR) regarding diagnosis, evaluation of treatment, and prognostication of patients with PAH. Recent Findings New CMR measures that have been proven relevant in PAH include measures of ventricular and atrial volumes and function, tissue characterization, pulmonary artery velocities, and arterio-ventricular coupling. Summary CMR markers carry prognostic information relevant for clinical care such as treatment response and thereby can affect survival. Future research should investigate if CMR, as a non-invasive method, can improve existing measures or even provide new and better measures in the diagnosis, evaluation of treatment, and determination of prognosis of PAH.

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Section: Late Gadolinium Enhancementmentioning

confidence: 99%

Cardiac Magnetic Resonance Imaging in Pulmonary Arterial Hypertension: Ready for Clinical Practice and Guidelines?

Kjellström

Lindholm

Ostenfeld

2020

Curr Heart Fail Rep

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“…Lastly, diffuse fibrosis could stiffen the myocardium and leads to decrease the ventricular volumes, leading to increased LVEF. In a recent study by Hromádka et al on SSc patients [32] the conventional echocardiography parameters were similar in SSc patients and controls. However, the global longitudinal peak systolic strain (GLPS) was lower in SSc patients compared to controls and correlated negatively with native T1 (30).…”

Section: Discussionmentioning

confidence: 87%

CMR feature tracking in cardiac asymptomatic systemic sclerosis: Clinical implications

et al. 2019

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Background Impaired myocardial deformation has been sporadically described in cardiac asymptomatic systemic sclerosis (SSc). We aimed to study myocardial deformation indices in cardiac asymptomatic SSc patients using cardiac magnetic resonance feature tracking (CMR-FT) and correlate these findings to the phenotypic and autoimmune background. Methods Fifty-four cardiac asymptomatic SSc patients (44 females, 56±13 years), with normal routine cardiac assessment and CMR evaluation, including cine and late gadolinium enhancement (LGE) images, were included. SSc patients were compared to 21 sex- and age- matched healthy controls (17 females; 54±19 years). For CMR-FT analysis, a mid-ventricular slice for LV peak systolic radial and circumferential strain and a 4-chamber view for LV/RV peak systolic longitudinal strain were used. Results Twenty-four patients had diffuse cutaneous SSc and 30 limited cutaneous SSc. Thirteen patients had digital ulcers. Median disease duration was 3.6 years. LV ejection fraction was higher in SSc patients compared to controls (62±6% vs. 59±5%, p = 0.01). Four patients had no LGE examination; in the remaining patients LGE was absent in 74%, while 18% had RV insertion fibrosis and 8% evidence of subendocardial infarction. LV longitudinal strain differed in those with insertion fibrosis (-18.0%) and infarction (-16.7%) compared to no fibrosis (-20.3%, p = 0.04). Patients with SSc had lower RV longitudinal strain and strain rate compared to controls (p<0.001 and p = 0.01, respectively). All other strain and strain rate measurements were non-significant between patients and controls. Conclusions In cardiac asymptomatic SSc patients with normal routine functional indices, CMR-FT identifies subclinical presence of insertion fibrosis and/or myocardial infarction by impaired LV longitudinal strain. RV derived longitudinal indices were impaired in the patient group. CMR FT indices did not correlate to the patients’ phenotypic and autoimmune features.

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“…Ntusi and colleagues evaluated, for the first time, cardiac MRI T1 mapping sequences in 19 SSc patients without overt cardiovascular disease . That study and others showed that SSc patients had significantly higher myocardial T1 values and larger areas of myocardial involvement compared to controls . Barison et al showed that SSc was associated not only with myocardial replacement fibrosis but also with interstitial remodeling of the myocardium, even in patients with normal biventricular function, thereby showing the potential usefulness of early identification of these abnormalities .…”

Section: Discussionmentioning

confidence: 99%

Cardiac Intravoxel Incoherent Motion Diffusion‐Weighted Magnetic Resonance Imaging With T1 Mapping to Assess Myocardial Perfusion and Fibrosis in Systemic Sclerosis: Association With Cardiac Events From a Prospective Cohort Study

Terrier

Dechartres

Gouya

et al. 2020

Arthritis & Rheumatology

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Objective Myocardial involvement may occur during systemic sclerosis (SSc) and can lead to impaired myocardial contraction and/or arrhythmia. Cardiac magnetic resonance imaging (MRI) is used for noninvasive characterization of the myocardium. The aim of this study was to evaluate the utility of cardiac MRI with intravoxel incoherent motion (IVIM) diffusion‐weighted imaging (DWI) and longitudinal relaxation time (T1) sequence mapping for assessment of myocardial microvascular and interstitium impairment in SSc. Methods In this single‐center prospective cohort study, 40 consecutive patients with SSc and 20 healthy controls were assessed by cardiac MRI with IVIM DWI and T1 mapping sequences on a 3T scanning system. Images were analyzed independently by 2 assessors, and Bland‐Altman plots were used to assess interreader concordance and reproducibility. Characteristics of the patients were compared according to quartiles of T1 and perfusion fraction (f‐coefficient) values, using exact Cochran‐Ermitage trend tests for qualitative variables and analysis of variance for quantitative variables. Kaplan‐Meier cardiac events–free survival curves were plotted and compared with a log‐rank test for trend. Results T1 values were higher in SSc patients than in healthy controls, and were higher in the diffuse cutaneous SSc (dcSSc) subset (P = 0.02). Higher T1 values were associated with the immunologic pattern seen in patients with the dcSSc form (P = 0.0001), a higher modified Rodnan skin thickness score (MRSS) (P = 0.003), and a higher frequency of interstitial lung disease (P = 0.03). Moreover, higher T1 values were correlated with higher MRSS scores (r = +0.32, P = 0.04) and reduced forced vital capacity (r = −0.34, P = 0.048), and tended to be correlated with reduced total lung capacity (r = −0.30, P = 0.07). Lower f‐coefficient values, as a measure of decreased tissue perfusion, were associated with less frequent use of vasodilators (P = 0.02 for angiotensin‐converting enzyme inhibitors and P = 0.06 for calcium‐channel blockers) and more frequent use of glucocorticoids (P = 0.02). The f‐coefficients were inversely correlated with the T1 values (r = −0.31, P = 0.02). Furthermore, higher T1 values were associated with higher incidence of cardiac events (log‐rank test for trend P = 0.03). Conclusion Increased T1 values, potentially suggesting microscopic fibrosis, were observed more frequently in patients with dcSSc, and higher T1 values were associated with interstitial lung disease and more frequent cardiac events during follow‐up. The results of this study show that cardiac MRI with T1 mapping sequences and IVIM DWI may be useful in assessing myocardial involvement in patients with SSc.

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Myocardial fibrosis detected by magnetic resonance in systemic sclerosis patients – Relationship with biochemical and echocardiography parameters

Cited by 42 publications

References 33 publications

Cardiac Magnetic Resonance Imaging in Pulmonary Arterial Hypertension: Ready for Clinical Practice and Guidelines?

Cardiac Magnetic Resonance Imaging in Pulmonary Arterial Hypertension: Ready for Clinical Practice and Guidelines?

CMR feature tracking in cardiac asymptomatic systemic sclerosis: Clinical implications

Cardiac Intravoxel Incoherent Motion Diffusion‐Weighted Magnetic Resonance Imaging With T1 Mapping to Assess Myocardial Perfusion and Fibrosis in Systemic Sclerosis: Association With Cardiac Events From a Prospective Cohort Study

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