Troponin I and echocardiography in patients with systemic sclerosis and matched population controls

Nordin, Annika; Svenungsson, Elisabet; Björnådal, Lena; Elvin, Kerstin; Larsson, Anders; Jensen‐Urstad, Kerstin

doi:10.1080/03009742.2016.1192217

Cited by 21 publications

(22 citation statements)

References 39 publications

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“…While cardiac involvement in SSc patients is robustly associated with a poor prognosis, conferring a nearly fivefold increased risk of mortality in our meta-analysis, no study had yet focused on the valvular manifestations of SSc. A recent article comparing echocardiography in SSc patients and a matched control population showed a greater frequency of valvular regurgitation and valvular replacement due to regurgitation [62]. Moreover, in a large multicenter French cohort, De Groote et al [63] reported 6.7% mitral regurgitation and 2.5% aortic regurgitations.…”

Section: Discussionmentioning

confidence: 99%

Survival and prognosis factors in systemic sclerosis: data of a French multicenter cohort, systematic review, and meta-analysis of the literature

et al. 2019

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Background Data on survival and prognosis factors in incident cohorts are scarce in systemic sclerosis (SStc). To describe survival, standardized mortality ratio (SMR), and prognosis factors in systemic sclerosis (SSc), we analyzed a multicenter French cohort of incident patients and performed a systematic review of the literature and meta-analysis. Methods A multicenter, French cohort study was conducted between January 1, 2000, and December 31, 2013. Patients were followed-up until July 1, 2016. A systematic review of the literature was carried out in MEDLINE and EMBASE up to July 2017. Meta-analysis was performed using all available data on SMR and hazard ratios of prognosis factors. Results A total of 625 patients (493 females, 446 lcSSc) were included. During the study period, 104 deaths (16.6%) were recorded and 133 patients were lost to follow-up. Overall survival rates at 1, 3, 5, and 10 years from diagnosis were 98.0%, 92.5%, 85.9%, and 71.7% respectively in the French cohort. Overall SMR was 5.73 (95% CI 4.68–6.94). Age at diagnosis > 60 years, diffuse cutaneous SSc, scleroderma renal crisis, dyspnea, 6-min walking distance (6MWD), forced vital capacity < 70%, diffusing capacity of the lungs for carbon monoxide < 70%, pulmonary hypertension (PH), telangiectasia, valvular disease, malignancy, anemia, and CRP > 8 mg/l were associated with a poorer survival after adjustment. Eighteen studies (11,719 patients) were included in the SMR meta-analysis and 36 studies (26,187 patients) in the prognosis factor analysis. Pooled SMR was 3.45 (95%CI 3.03–3.94). Age at disease onset, male sex, African origin, diffuse cutaneous SSc, anti-Scl70 antibodies, cardiac and renal involvement, interstitial lung disease, PH, and malignancy were significantly associated with a worse prognosis. Anti-centromere antibodies were associated with a better survival. Conclusions Overall, our study highlights a high mortality rate in SSc patients and confirms previously described prognosis factors related to skin extension and organ involvement while identifying additional prognosis factors such as autoantibody status, telangiectasia, 6MWD, and valvular disease. Electronic supplementary material The online version of this article (10.1186/s13075-019-1867-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Survival and prognosis factors in systemic sclerosis: data of a French multicenter cohort, systematic review, and meta-analysis of the literature

et al. 2019

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“…Serum CV biomarkers, hs-TnI and NT-proBNP, are sensitive tools in the detection of cardiac pathology in the general population, and in SSc [18, 19]. To our knowledge, ours is the first study to associate primary SHD arrhythmias with hs-TnI and NT-proBNP, implicating myocardial injury.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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.

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“…High-sensitivity cardiac Troponin T has been found significantly increased in SSc patients compared with controls, and along with NT-proBNP, it had a high negative predictive value for precapillary pulmonary hypertension in this population (101). Finally, in another recent study, higher NT-proBNP and high-sensitivity cardiac Troponin I levels were found in SSc patients compared with controls, both of which were associated with the presence of echocardiographic abnormalities (102).…”

Section: Primary Myocardial Diseasementioning

confidence: 89%

Update on assessment and management of primary cardiac involvement in systemic sclerosis

Bournia

Tountas

Protogerou

et al. 2018

Journal of Scleroderma and Related Disorders

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Primary cardiac involvement is a common and severe complication of systemic sclerosis, which may affect all of the hearts' structural components, including pericardium, myocardium, endocardium, cardiac valves, and conduction system. While cardiac disease can be clinically silent and only diagnosed in autopsy, new imaging modalities such as speckle-tracking echocardiography and cardiovascular magnetic resonance may reveal various abnormal findings in the majority of patients. Cardiovascular magnetic resonance evaluation should include assessment of left and right ventricular function, inflammation (STIR T2-weighted sequences (T2-W) for edema detection), and fibrosis (T1-weighted sequences 15 min after Gd-DTPA contrast medium injection (late-gadolinium enhancement). Notably, cardiac disease is responsible for about one-fourth of systemic sclerosis-related deaths. Systematic studies for the assessment and therapy of systemic sclerosis-related cardiac complications, as well as relevant guidelines from the European League Against Rheumatism and the American College of Rheumatology, are currently lacking. However, research advances reviewed herein allow for a better understanding of the mechanisms that alter cardiac function. Implementation of such knowledge should reduce cardiac morbidity and mortality in systemic sclerosis patients.

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Troponin I and echocardiography in patients with systemic sclerosis and matched population controls

Cited by 21 publications

References 39 publications

Survival and prognosis factors in systemic sclerosis: data of a French multicenter cohort, systematic review, and meta-analysis of the literature

Survival and prognosis factors in systemic sclerosis: data of a French multicenter cohort, systematic review, and meta-analysis of the literature

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

Update on assessment and management of primary cardiac involvement in systemic sclerosis

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