National Referral Center for Systemic Autoimmune Diseases RESO, University Hospital of Strasbourg, France; Clinical Immunology and Internal Medicine, University Hospital of Strasbourg, France.
National Referral Center for Systemic Autoimmune Diseases RESO, University Hospital of Strasbourg, France; Rheumatology, University Hospital of Strasbourg, France.
Semin Arthritis Rheum. 2020 Feb;50(1):128-134. doi: 10.1016/j.semarthrit.2019.06.013. Epub 2019 Jun 19.
cardiac involvement is the second most frequent systemic sclerosis (SSc) related cause of death. It remains mostly asymptomatic in the early stage and is underdiagnosed with routine screening. Cardiac magnetic resonance imaging (CMR) could improve cardiac assessment of patients and noteworthily, new sequences allow the detection of diffuse myocardial fibrosis (DMF) by native T1 mapping. The aim of this study was to determine the prevalence of cardiac involvement by CMR native T1 mapping and its correlation with echocardiography data and non-cardiac manifestations in SSc patients.
patients fulfilling the ACR/EULAR classification criteria for SSc were prospectively included between 2014 and 2016. They underwent CMR at 1.5T, including native T1 and T2 mapping, and Late Gadolinium Enhancement (LGE) as a part of routine follow up. Routine biological tests (mainly BNP and CRP) were centralized in the hospital laboratory.
seventy-two unselected patients were included. Thirty six patients (50%) had elevated T1 (ET1) (mean T1 1097±14 ms). CMR cardiac functional parameters were similar in ET1 and normal T1 (NT1). Echocardiography was normal in 18 (50%) of ET1. ET1 and NT1 groups were similar for cardiovascular risk factors and ischemic heart disease. ET1 was not correlated with any clinical or echocardiographic parameter or antibody profile. Thirty-six percent of patients with ET1 had no cardiac symptoms, normal echocardiography and CMR LVEF, and no LGE.
native T1 mapping detects left ventricular ET1 (potential DMF) in 50% of patients with SSc and a third of them had a normal conventional screening including standard CMR. In the future, further studies are needed to confirm the benefit of use of native T1 mapping as a part of routine follow up to detect earlier pejorative cardiac involvement in SSc patients.
心脏受累是系统性硬化症（SSc）第二大常见的系统性疾病死亡原因。在早期阶段，它大多没有症状，常规筛查也未能发现。心脏磁共振成像（CMR）可以改善患者的心脏评估，值得注意的是，新序列可以通过心肌固有 T1 映射检测弥漫性心肌纤维化（DMF）。本研究旨在通过 CMR 心肌固有 T1 映射确定 SSc 患者心脏受累的发生率及其与超声心动图数据和非心脏表现的相关性。
2014 年至 2016 年间，前瞻性纳入符合 ACR/EULAR SSc 分类标准的患者。他们在 1.5T 上进行 CMR，包括心肌固有 T1 和 T2 映射以及晚期钆增强（LGE），作为常规随访的一部分。常规生物学测试（主要是 BNP 和 CRP）在医院实验室进行集中检测。
共纳入 72 例未经选择的患者。36 例患者（50%）心肌 T1 升高（ET1）（平均 T1 为 1097±14ms）。ET1 和正常 T1（NT1）患者的 CMR 心功能参数相似。18 例 ET1 患者（50%）超声心动图正常。ET1 和 NT1 组的心血管危险因素和缺血性心脏病相似。ET1 与任何临床或超声心动图参数或抗体特征均无相关性。36%的 ET1 患者无心脏症状、超声心动图和 CMR LVEF 正常且无 LGE。
心肌固有 T1 映射在 50%的 SSc 患者中检测到左心室 ET1（潜在的 DMF），其中三分之一的患者常规筛查包括标准 CMR 正常。未来需要进一步研究，以确认将心肌固有 T1 映射作为常规随访的一部分用于检测 SSc 患者早期不良心脏受累的益处。
