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
