Zhao Z, Zhao Y N, Jin J Y, Yang J S, Zhu J, Li T
Department of Rheumatology and Immunology,the First Medical Center of the Chinese PLA General Hospital, Beijing 100853, China.
Department of Radiology, the First Medical Center of the Chinese PLA General Hospital, Beijing 100853, China.
Zhonghua Nei Ke Za Zhi. 2024 Feb 1;63(2):176-182. doi: 10.3760/cma.j.cn112138-20231101-00277.
Primary cardiac involvement (SSc-PHI) in systemic sclerosis is an important prognostic factor. We aimed to characterize and identify subclinical SSc-PHI using cardiovascular MRI to determine whether disease severity and serum biomarkers are associated with subclinical SSc-PHI. A total of 26 patients with SSc who had no history of cardiovascular disease or pulmonary hypertension underwent 3 T-enhanced cardiovascular MRI. Measurements included native T, extracellular volume, advanced gadolinium enhancement, T mapping, and left ventricular volume function. Troponin T and N telencephalic natriuretic peptide precursors were also determined. LGE was observed in 13 of 26 patients (50.0%), suggesting focal fibrosis, and T mapping was significantly higher in the dcSSc group than in the lcSSc group (=0.009). Left ventricular volume and function were within the normal range in all patients, but final systolic left ventricular volume was significantly higher in dcSSc than in lcSSc (=0.021). The modified Rodnan skin score (mRSS) was significantly higher in patients with LGE focal fibrosis (=0.019). Logistic regression analysis confirmed the association between mRSS and LGE (=1.224, =0.037). In multivariate analysis, T mapping was negatively correlated with disease course, and was correlated with dcSSc and fingertip ulcer (=0.711, =0.018, =0.013, =0.030). Troponin T was correlated with T mapping (=0.555, =0.049). Subclinical SSc-PHI is characterized by diffuse and focal myocardial fibrosis, but preserves myocardial systolic function. Subclinical SSC-Phi is associated with TNT, SSc disease severity, and complex peripheral vascular disease. These data provide information for identifying individuals at risk of SSc-PHI.
系统性硬化症中的原发性心脏受累（SSc-PHI）是一个重要的预后因素。我们旨在利用心血管磁共振成像来表征和识别亚临床SSc-PHI，以确定疾病严重程度和血清生物标志物是否与亚临床SSc-PHI相关。共有26例无心血管疾病或肺动脉高压病史的系统性硬化症患者接受了3T增强心血管磁共振成像检查。测量指标包括固有T、细胞外容积、晚期钆增强、T映射以及左心室容积功能。还测定了肌钙蛋白T和N末端脑钠肽前体。26例患者中有13例（50.0%）观察到晚期钆增强，提示局灶性纤维化，dcSSc组的T映射显著高于lcSSc组（P=0.009）。所有患者的左心室容积和功能均在正常范围内，但dcSSc患者的最终收缩末期左心室容积显著高于lcSSc患者（P=0.021）。有局灶性纤维化晚期钆增强的患者改良Rodnan皮肤评分（mRSS）显著更高（P=0.019）。逻辑回归分析证实mRSS与晚期钆增强之间存在关联（比值比=1.224，P=0.037）。在多变量分析中，T映射与病程呈负相关，且与dcSSc和指尖溃疡相关（比值比=0.711，P=0.018；比值比=0.013，P=0.030）。肌钙蛋白T与T映射相关（r=0.555，P=0.049）。亚临床SSc-PHI的特征是弥漫性和局灶性心肌纤维化，但保留心肌收缩功能。亚临床SSc-Phi与肌钙蛋白T、系统性硬化症疾病严重程度以及复杂的外周血管疾病相关。这些数据为识别有SSc-PHI风险的个体提供了信息。
