253Cardiovascular magnetic resonance pattern of acute cardiac events in systemic sclerosis

Le résumé fourni par la source

Background: In patients with systemic sclerosis (SSc) cardiovascular disease is perhaps the most significant cause of death. Due to the insidious and oligosymptomatic progression of myocardial involvement in SSc, its diagnosis remains a challenge using echocardiography, the most commonly employed modality. We hypothesized that SSc patients with a normal echocardiogram that experienced a clinical event would have a different cardiovascular magnetic resonance (CMR) profile than those that did not experience an event. Methods: 43 diffuse cutaneous SSc (dcSSc) patients were evaluated with CMR using a 1.5T scanner. 27 (63%) had experienced an adverse clinical event 3-10 days before the examination (atrial fibrillation-AF; recent onset angina pectoris-AP; sudden cardiac death-SCD; paroxysmal ventricular tachycardia-VT; other ventricular rhythm disturbances-VRDs; recent onset shortness of breath-SOB). 16 (37%) patients experienced no such events during that time. The left/right ventricular (LV/RV) end-systolic volume (ESV), end-diastolic volume (EDV) and ejection fraction (EF), as well as the T2 signal ratio (myocardium/skeletal muscle), early and late gadolinium enhancement (EGE/LGE), native/post-contrast T1-mapping, T2 mapping and extracellular volume fraction (ECV) values were compared between the two groups. Results: The event group did not differ significantly from the non-event group with regard to age [median (IQR): 54.0 (39.0-61.0) vs. 54.5 (46.0-58.0), p = 0.66]. 15 (55.6%) patients in the event group experienced AP, 4 (14.8%) experienced VT, 3 (11.1%) experienced SOB, 2 (7.4%) experienced SCD, 2 (7.4%) experienced VRDs and 1 (3.7) experienced AF. The two groups had similar LV and RV systolic function (Table 1). Patients in the event group had noticeably higher T2-signal ratio compared to the non-event group [median (IQR): 2.4 (1.9-2.7) vs. 1.9 (1.8-2.2), p = 0.005] as was the case for LGE [median (IQR): 7.0 (5.0-12.0) vs. 3.0 (0.0-5.0), p < 0.001], T2-mapping [median (IQR): 63.0 (55.0-64.0) vs. 53.0 (49.5-56.5), p < 0.001] and native T1-mapping [median (IQR): 1152.0 (1120.0-1202.0) vs. 1061.5 (1021.5-1127.0), p = 0.001]. Smaller but significant differences between groups were identified in EGE, post-contrast T1-mapping and ECV. Conclusions: In dcSSc patients, tissue characterization indices but not cardiac functional indices demonstrate significant differences between patients that did or did not experience an event. As such, CMR should be the investigation of choice for evaluating cardiac involvement in dcSSc patients with normal echocardiography findings and a clinical event, in order to investigate the underlying pathophysiologic background and institute necessary changes in treatment.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.