Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
J Cardiol. 2023 Aug;82(2):100-107. doi: 10.1016/j.jjcc.2023.03.003. Epub 2023 Mar 13.
Systemic sclerosis (SSc) is divided into diffuse and limited cutaneous SSc (dcSSc and lcSSc). The dcSSc subtype has more severe internal organ damage. This study aimed to assess whether cardiovascular magnetic resonance (CMR) parametric mapping could detect early cardiac involvement and evaluate differences between these two subtypes.
Eighty SSc patients (37 dcSSc and 43 lcSSc) underwent CMR at 3.0 T (Philips Healthcare, Best, The Netherlands) in our hospital between July 2018 and July 2021. We analyzed myocardial damage by CMR parametric mapping and compared it with clinical data.
The median duration of the disease was 10.2 months. The left ventricular ejection fraction was preserved in both groups. DcSSc had significantly higher native T1 (1333.4 ± 71.2 ms vs. 1295.0 ± 42.7 ms, p = 0.006) and extracellular volume fraction (32.6 ± 4.1 % vs. 30.3 ± 4.0 %, p = 0.018) in the mid-ventricular septum as compared to lcSSc, although there were no differences in T2 values. Native T1 values were positively correlated with the E/e' ratio and left atrial volume indices evaluated by transthoracic echocardiography in overall SSc and dcSSc, but not in lcSSc. Logistic regression analysis revealed that native T1 was an independent predictor of left ventricular diastolic dysfunction in SSc patients (odds ratio, 1.194; 95 % confidence interval, 1.021-1.396; p = 0.026). Native T1 was higher in SSc patients with progressive skin lesions. Additionally, there were positive correlations between brain natriuretic peptide, New York Heart Association functional classification, and native T1.
CMR parametric mapping is a useful tool for detecting myocardial changes. Native T1 was the most sensitive parameter for identifying diffuse myocardial changes in the early stages of SSc and was associated with left ventricular diastolic function. DcSSc had more severe myocardial involvement than lcSSc; therefore, the use of CMR parametric mapping may aid in its prediction.
系统性硬化症（SSc）分为弥漫性和局限性皮肤型 SSc（dcSSc 和 lcSSc）。dcSSc 亚型有更严重的内脏器官损伤。本研究旨在评估心血管磁共振（CMR）参数图是否能早期检测到心脏受累，并评估这两种亚型之间的差异。
2018 年 7 月至 2021 年 7 月，在我院使用 3.0T 磁共振成像仪（荷兰飞利浦医疗保健公司）对 80 例 SSc 患者（37 例 dcSSc 和 43 例 lcSSc）进行 CMR 检查。我们通过 CMR 参数图分析心肌损伤，并与临床数据进行比较。
疾病的中位病程为 10.2 个月。两组左心室射血分数均正常。与 lcSSc 相比，dcSSc 的左心室中隔心肌的 native T1（1333.4±71.2ms 比 1295.0±42.7ms，p=0.006）和细胞外容积分数（32.6±4.1%比 30.3±4.0%，p=0.018）明显更高，尽管 T2 值无差异。在整个 SSc 患者和 dcSSc 患者中，native T1 值与经胸超声心动图评估的 E/e' 比值和左心房容积指数呈正相关，但在 lcSSc 患者中无相关性。Logistic 回归分析显示，在 SSc 患者中，native T1 是左心室舒张功能障碍的独立预测因子（比值比，1.194；95%置信区间，1.021-1.396；p=0.026）。SSc 患者皮损进展时 native T1 值较高。此外，脑钠肽、纽约心脏协会功能分级与 native T1 值之间存在正相关关系。
CMR 参数图是一种检测心肌变化的有用工具。在 SSc 的早期阶段，native T1 是识别弥漫性心肌变化的最敏感参数，与左心室舒张功能有关。dcSSc 比 lcSSc 有更严重的心肌受累，因此使用 CMR 参数图可能有助于预测。
