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Gotschy A, Jordan S, Stoeck CT, von Deuster C, Peer T, Gastl M, Vishnevskiy V, Wissmann L, Dobrota R, Mihai C, Becker MO, Maurer B, Kozerke S, Ruschitzka F, Distler O, Manka R. Diffuse myocardial fibrosis precedes subclinical functional myocardial impairment and provides prognostic information in systemic sclerosis. Eur Heart J Cardiovasc Imaging 2023; 24:373-382. [PMID: 35639682 DOI: 10.1093/ehjci/jeac094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 04/12/2022] [Accepted: 05/05/2022] [Indexed: 02/18/2023] Open
Abstract
AIMS Myocardial involvement is common in patients with systemic sclerosis (SSc) and causes myocardial fibrosis and subtle ventricular dysfunction. However, the temporal onset of myocardial involvement during the progression of the disease and its prognostic value are yet unknown. We used cardiovascular magnetic resonance (CMR) to investigate subclinical functional impairment and diffuse myocardial fibrosis in patients with very early diagnosis of SSc (VEDOSS) and established SSc and examined whether this was associated with mortality. METHODS AND RESULTS One hundred and ten SSc patients (86 established SSc, 24 VEDOSS) and 15 healthy controls were prospectively recruited. The patients were followed-up for a median duration of 7.0 years (interquartile range 6.0-7.3 years). Study subjects underwent CMR including assessment of myocardial fibrosis [native T1 and extracellular volume (ECV)] and measurement of global longitudinal (GLS) and circumferential (GCS) myocardial strain. Native T1 values and ECV were elevated in VEDOSS and SSc patients compared with controls (P < 0.001). GLS was similar in VEDOSS and controls but significantly impaired in patients with established SSc (P < 0.001). GCS was similar over all groups (P = 0.88). There were 12 deaths during follow-up. Elevated native T1 [hazard ratio (HR) 5.8, 95% confidence interval (CI): 1.7-20.4; P = 0.006] and reduced GLS (HR 6.1, 95% CI: 1.3-29.9; P = 0.038) identified subjects with increased risk of death. Only native T1 was predictive for cardiovascular mortality (P < 0.001). CONCLUSION Subclinical myocardial involvement first manifests as diffuse myocardial fibrosis identified by the expansion of ECV and increased native T1 in VEDOSS patients while subtle functional impairment only occurs in established SSc. Native T1 and GLS have prognostic value for all-cause mortality in SSc patients.
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Affiliation(s)
- Alexander Gotschy
- Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Suzana Jordan
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christian T Stoeck
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | | | - Tatiana Peer
- Cardiology Department, Stadtspital Waid and Triemli, Zurich, Switzerland
| | - Mareike Gastl
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.,Department of Cardiology, Pneumology and Angiology, Heinrich Heine University, Düsseldorf, Germany
| | - Valery Vishnevskiy
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Lukas Wissmann
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.,Department of Radiation Oncology, Spital Thurgau AG, Münsterlingen, Switzerland
| | - Rucsandra Dobrota
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Carina Mihai
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mike O Becker
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Britta Maurer
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Rheumatology and Immunology, University Hospital Bern, Bern, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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