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Cardiac Magnetic Resonance Imaging Detects Subclinical Right Ventricular Impairment in Systemic Sclerosis
GIAN PAOLO BEZANTE, DANIELA ROLLANDO, MARTA SESSAREGO, NICOLETTA PANICO, MAURIZIO SETTI, GILBERTO FILACI, GIUSEPPE MOLINARI, MANRICO BALBI, MAURIZIO CUTOLO, ANTONIO BARSOTTI, FRANCESCO INDIVERI, and MASSIMO GHIO
ABSTRACT. Methods. Fifty patients (45 women, 5 men, age 53.3 ± 12.9 yrs) who did not complain of serious diseases other than SSc were recruited out of 119 consecutive patients with SSc. Thirty-three were found to have limited cutaneous SSc (lSSc) and 17 diffuse SSc (dSSc). All underwent cardiovascular magnetic resonance imaging (MRI) to determine right and left systolic and diastolic volumes and ventricular ejection fractions (RVEF and LVEF). Thirty-one healthy subjects matched for sex, age, and body surface area (BSA) were studied as controls. Diffusion lung capacity test (DLCO) and high resolution computed tomography were performed to evaluate lung involvement. Results. Disease duration between patients with lSSc (14.1 ± 11.4 yrs) and those with dSSc (6.9 ± 4.4yrs) was found to be significantly different (p < 0.003). lSSc patients were older than those with dSSc (54.8 ± 13.7 yrs vs 50.4 ± 9.9 yrs, respectively; p < 0.04). Anticentromere antibodies and Scl-70 were positive in 23 (46%) and 17 patients (34%). Except for the left and right systolic volumes, all unadjusted cardiac MRI measures were significantly reduced in SSc compared to the controls (p < 0.001 and p < 0.009). These differences persisted after adjustment for subjects' height and BSA. Raw RVEF data and RVEF data matched for height and BSA were significantly reduced in dSSc patients in comparison to lSSc (p < 0.03). Conclusion. Compromised RVF was found in patients with asymptomatic SSc. Unlike standard diagnostic techniques, cardiac MRI appears to be a rapid and noninvasive means of determining subclinical right myocardial involvement that is otherwise undetected in patients with SSc. (First Release Nov 1 2007; J Rheumatol 2007;34:2431-7) Key Indexing Terms:
CARDIAC MAGNETIC RESONANCE IMAGING
From the Division of Cardiology, Division of Immunology, and Division of Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy. G.P. Bezante, MD, FACC; D. Rollando, MD; G. Molinari, MD; M. Balbi, MD; A. Barsotti, MD, Cardiology Unit; M. Sessarego, MD; N. Panico, MD; M. Setti, MD; G. Filaci, MD; F. Indiveri, MD; M. Ghio, MD, Immunology Unit; M. Cutolo, MD, Rheumatology Unit, Department of Internal Medicine, University of Genoa. Address reprint requests to Dr. G.P. Bezante, Cardiology Unit, Department of Internal Medicine, University of Genoa, Viale Benedetto XV/6, 16132 Genoa, Italy. E-mail: gian.paolo.bezante@unige.it Accepted for publication August 22, 2007. |
