Kobayashi Hitomi, Yokoe Isamu, Hirano Masaharu, Nakamura Tetsuya, Nakajima Yasuo, Fontaine Kevin R, Giles Jon T, Kobayashi Yasuyuki
Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 4100, Baltimore, MD 21224, USA.
J Rheumatol. 2009 Jan;36(1):106-12. doi: 10.3899/jrheum.080377.
To assess cardiac involvement in asymptomatic patients with systemic sclerosis (SSc) by cardiac magnetic resonance imaging (MRI).
Ten asymptomatic patients with SSc (all female; mean age 59.5+/-9.4 yrs) underwent contrast enhanced cardiac MRI on a 1.5 T MRI device. Adenosine triphosphate was used for stress and rest perfusion to assess perfusion defects due to microvascular impairment or ischemia, and delayed enhanced (DE) imaging was obtained for the assessment of myocardial necrosis and fibrosis. We evaluated the pathophysiological associations of stress perfusion combined with DE imaging with SSc disease severity measures.
Stress perfusion defects were seen in 5 out of 9 patients (56%): 4 had nonsegmental subendocardial perfusion defects and one had a segmental subendocardial perfusion defect. Three patients were found to have DE. DE was not observed in any patient without perfusion defect; and among the 5 patients with perfusion defects, 3 (60%) had DE. Two of the 3 had DE in segments not matching the region of nonsegmental perfusion defects. The remaining one had a segmental subendocardial DE matching the region of a segmental perfusion defect. Perfusion defects were seen in 75% of patients with a history of digital ulceration compared to only 20% of those without history of ulceration.
Subclinical myocardial involvement, as detected by cardiac MRI, was frequent in asymptomatic patients with SSc. Cardiac MRI may aid in understanding the pathophysiological mechanism of SSc.
通过心脏磁共振成像（MRI）评估系统性硬化症（SSc）无症状患者的心脏受累情况。
10例无症状SSc患者（均为女性；平均年龄59.5±9.4岁）在1.5T MRI设备上接受对比增强心脏MRI检查。使用三磷酸腺苷进行负荷和静息灌注，以评估微血管损伤或缺血导致的灌注缺损，并获取延迟强化（DE）成像以评估心肌坏死和纤维化。我们评估了负荷灌注联合DE成像与SSc疾病严重程度指标之间的病理生理关联。
9例患者中有5例（56%）出现负荷灌注缺损：4例有非节段性心内膜下灌注缺损，1例有节段性心内膜下灌注缺损。发现3例患者有DE。在无灌注缺损的患者中未观察到DE；在5例有灌注缺损的患者中，3例（60%）有DE。3例中有2例的DE出现在与非节段性灌注缺损区域不匹配的节段。其余1例有节段性心内膜下DE，与节段性灌注缺损区域匹配。有指端溃疡病史的患者中75%出现灌注缺损，而无溃疡病史的患者中仅20%出现灌注缺损。
心脏MRI检测到的亚临床心肌受累在无症状SSc患者中很常见。心脏MRI可能有助于理解SSc的病理生理机制。
