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CMR feature tracking in cardiac asymptomatic systemic sclerosis : Clinical implications

Bratis, Konstantinos ; Lindholm, Anthony LU ; Hesselstrand, Roger LU ; Arheden, Håkan LU ; Karabela, Georgia ; Stavropoulos, Efthymios ; Katsifis, Gikas ; Kolovou, Genovefa ; Kitas, George D and Sfikakis, Petros P , et al. (2019) In PLoS ONE 14(8). p.1-13
Abstract

BACKGROUND: Impaired myocardial deformation has been sporadically described in cardiac asymptomatic systemic sclerosis (SSc). We aimed to study myocardial deformation indices in cardiac asymptomatic SSc patients using cardiac magnetic resonance feature tracking (CMR-FT) and correlate these findings to the phenotypic and autoimmune background.

METHODS: Fifty-four cardiac asymptomatic SSc patients (44 females, 56±13 years), with normal routine cardiac assessment and CMR evaluation, including cine and late gadolinium enhancement (LGE) images, were included. SSc patients were compared to 21 sex- and age- matched healthy controls (17 females; 54±19 years). For CMR-FT analysis, a mid-ventricular slice for LV peak systolic radial and... (More)

BACKGROUND: Impaired myocardial deformation has been sporadically described in cardiac asymptomatic systemic sclerosis (SSc). We aimed to study myocardial deformation indices in cardiac asymptomatic SSc patients using cardiac magnetic resonance feature tracking (CMR-FT) and correlate these findings to the phenotypic and autoimmune background.

METHODS: Fifty-four cardiac asymptomatic SSc patients (44 females, 56±13 years), with normal routine cardiac assessment and CMR evaluation, including cine and late gadolinium enhancement (LGE) images, were included. SSc patients were compared to 21 sex- and age- matched healthy controls (17 females; 54±19 years). For CMR-FT analysis, a mid-ventricular slice for LV peak systolic radial and circumferential strain and a 4-chamber view for LV/RV peak systolic longitudinal strain were used.

RESULTS: Twenty-four patients had diffuse cutaneous SSc and 30 limited cutaneous SSc. Thirteen patients had digital ulcers. Median disease duration was 3.6 years. LV ejection fraction was higher in SSc patients compared to controls (62±6% vs. 59±5%, p = 0.01). Four patients had no LGE examination; in the remaining patients LGE was absent in 74%, while 18% had RV insertion fibrosis and 8% evidence of subendocardial infarction. LV longitudinal strain differed in those with insertion fibrosis (-18.0%) and infarction (-16.7%) compared to no fibrosis (-20.3%, p = 0.04). Patients with SSc had lower RV longitudinal strain and strain rate compared to controls (p<0.001 and p = 0.01, respectively). All other strain and strain rate measurements were non-significant between patients and controls.

CONCLUSIONS: In cardiac asymptomatic SSc patients with normal routine functional indices, CMR-FT identifies subclinical presence of insertion fibrosis and/or myocardial infarction by impaired LV longitudinal strain. RV derived longitudinal indices were impaired in the patient group. CMR FT indices did not correlate to the patients' phenotypic and autoimmune features.

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published
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PLoS ONE
volume
14
issue
8
article number
e0221021
pages
1 - 13
publisher
Public Library of Science
external identifiers
  • pmid:31433819
  • scopus:85070942808
ISSN
1932-6203
DOI
10.1371/journal.pone.0221021
language
English
LU publication?
yes
id
3a205417-9da2-4681-814c-6097b97b95ea
date added to LUP
2019-08-22 18:41:33
date last changed
2020-01-13 02:17:34
@article{3a205417-9da2-4681-814c-6097b97b95ea,
  abstract     = {<p>BACKGROUND: Impaired myocardial deformation has been sporadically described in cardiac asymptomatic systemic sclerosis (SSc). We aimed to study myocardial deformation indices in cardiac asymptomatic SSc patients using cardiac magnetic resonance feature tracking (CMR-FT) and correlate these findings to the phenotypic and autoimmune background.</p><p>METHODS: Fifty-four cardiac asymptomatic SSc patients (44 females, 56±13 years), with normal routine cardiac assessment and CMR evaluation, including cine and late gadolinium enhancement (LGE) images, were included. SSc patients were compared to 21 sex- and age- matched healthy controls (17 females; 54±19 years). For CMR-FT analysis, a mid-ventricular slice for LV peak systolic radial and circumferential strain and a 4-chamber view for LV/RV peak systolic longitudinal strain were used.</p><p>RESULTS: Twenty-four patients had diffuse cutaneous SSc and 30 limited cutaneous SSc. Thirteen patients had digital ulcers. Median disease duration was 3.6 years. LV ejection fraction was higher in SSc patients compared to controls (62±6% vs. 59±5%, p = 0.01). Four patients had no LGE examination; in the remaining patients LGE was absent in 74%, while 18% had RV insertion fibrosis and 8% evidence of subendocardial infarction. LV longitudinal strain differed in those with insertion fibrosis (-18.0%) and infarction (-16.7%) compared to no fibrosis (-20.3%, p = 0.04). Patients with SSc had lower RV longitudinal strain and strain rate compared to controls (p&lt;0.001 and p = 0.01, respectively). All other strain and strain rate measurements were non-significant between patients and controls.</p><p>CONCLUSIONS: In cardiac asymptomatic SSc patients with normal routine functional indices, CMR-FT identifies subclinical presence of insertion fibrosis and/or myocardial infarction by impaired LV longitudinal strain. RV derived longitudinal indices were impaired in the patient group. CMR FT indices did not correlate to the patients' phenotypic and autoimmune features.</p>},
  author       = {Bratis, Konstantinos and Lindholm, Anthony and Hesselstrand, Roger and Arheden, Håkan and Karabela, Georgia and Stavropoulos, Efthymios and Katsifis, Gikas and Kolovou, Genovefa and Kitas, George D and Sfikakis, Petros P and Koutsogeorgopoulou, Loukia and Mavrogeni, Sophie and Ostenfeld, Ellen},
  issn         = {1932-6203},
  language     = {eng},
  month        = {08},
  number       = {8},
  pages        = {1--13},
  publisher    = {Public Library of Science},
  series       = {PLoS ONE},
  title        = {CMR feature tracking in cardiac asymptomatic systemic sclerosis : Clinical implications},
  url          = {http://dx.doi.org/10.1371/journal.pone.0221021},
  doi          = {10.1371/journal.pone.0221021},
  volume       = {14},
  year         = {2019},
}