Background: Diffuse systemic sclerosis (dSSc) is characterized by
vascular lesions and fibrosis. Cardiac involvement, although silent,
accounts for 36% of deaths. We hypothesized that cardiovascular
magnetic resonance (CMR) can clarify the pathophysiology of Q waves in
dSSc patients.
Patients-methods: 105 dSSc, aged 48 +/- 2 years, with atypical symptoms
and normal routine assessment, were evaluated by ECG and CMR using a 1.5
T system. Biventricular function was assessed by steady-state
free-precession sequence (SSFP). To identify fibrosis, late gadolinium
enhanced areas (LGE) were evaluated 15 min after injection of 0.2
mmol/kg gadolinium-DTPA and expressed as % of LV mass.
Results: Q waves in V1-V5 (Group A), II, III, AVF (Group B) and I, AVL,
II, III, AVF, V1-V5 (Group C) were found in 25/105, 8/105 and 5/105
dSSc, respectively. In 25 dSSc with Q in V1-V6, patchy intramyocardial
LGE was detected in 24/25 and involved 8 +/- 2% of LV mass. LGE
involved the intraventricular septum (IVS) in 11/24 and the lateral wall
(LAT) in 5/24 dSSc. Only in 1/25 dSSc, an anterior, transmural LGE, due
to LAD occlusion, was identified. In 8 dSSc with Q in II, III, AVF,
patchy intramyocardial LGE was detected in the inferior wall and
involved 5 +/- 2% of LV mass. In 5 dSSc with Q in V1-V5, II, III, AVF,
patchy intramyocardial LGE was detected in anterior and inferolateral
wall and involved 9 +/- 2% of LV mass.
Conclusion: CMR unveiled that the pattern of myocardial fibrosis in dSSc
with Q waves is due to the systemic disease and not to CAD. (C) 2016
Elsevier Ireland Ltd. All rights reserved
