The Role of Cardiac Magnetic Resonance Imaging Parameters in Prognostication of Systemic Sclerosis in Patients with Cardiac Involvement: A Systematic Review of the Literature.

BACKGROUND

Systemic sclerosis (SSc) is an immune dysregulation disorder affecting multiple organs. Cardiac involvement, prevalently myocardial, is associated with poor outcomes in SSc patients. Several investigations explored the role of cardiac magnetic resonance (CMR) imaging in the diagnosis of scleroderma-related cardiomyopathy and analyzed the clinical, radiologic, and pathologic correlations utilizing CMR examinations. However, fewer studies investigated the role of traditional and novel CMR parameters, including functional values, strain, late gadolinium enhancement (LGE), and parametric mapping variables, in predicting outcomes in SSc patients. We aimed to review the literature to seek for the role of different CMR features in outcome prediction of SSc patients.

METHODS

We systematically reviewed PubMed/Medline, EMBASE, Web of Science, and Scopus databases to find publications that analyzed the prognostic value of CMR-derived parameters for adverse events, particularly all-cause mortality, in SSc patients published from January of 1960, up to the May 1, 2023. In this regard, we excluded the reviews, editorials, case reports, and case series. Also, we excluded the studies with the target population possessing obstructive coronary artery disease, other rheumatologic conditions, moderate to severe pulmonary hypertension and history of intervention for arrhythmia. Two of the authors principally extracted data, and disagreements were resolved through consensus. Information from each investigation was registered. Two of the authors utilized the Quality in Prognostic Studies (QUIPS) tool for risk of bias assessment, and a third reviewer was involved in cases of inconsistencies. Consequently, the main findings of the conducted projects were outlined and depicted in tables.

RESULTS

The initial search yielded 4623 papers. After removing duplicates and irrelevant titles/abstracts, 120 full-text articles were reviewed. Nine studies met the criteria with study population ranging from 24 to 260 patients in included studies. The following CMR parameters were powerful predictors of all-cause mortality: myocardial LGE, native T1 value, extracellular volume (ECV), and ventricular strain. Although less studied, left atrial strain, diffusion/perfusion, and stress-CMR parameters were also predictors of outcomes.

DISCUSSION

In SSc patients, CMR findings, including myocardial LGE, native T1 value, ECV, and ventricular strain values, were robust predictors of adverse outcomes. Other CMR parameters, consisting of diffusion/perfusion and stress-CMR values, were less studied. A drawback encountered while we were reviewing the studies was the versatility of measurement criteria among the included studies that precluded us from driving a meta-analysis. Further longitudinal multiparametric CMR studies are required to investigate the prognostic role of CMR examination in SSc patients.

REGISTRATION

The systematic review protocol containing the planned methods was registered in PROSPERO before starting the review process (PROSPERO, registration ID: CRD42023446391).