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Prognostic value of cardiac magnetic resonance in systemic sclerosis

Session Poster session 1

Speaker Alessia Pepe

Congress : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance
  • Session type : Poster Session
  • FP Number : P137

Authors : A Pepe (Pisa,IT), A Meloni (Pisa,IT), C Bruni (Florence,IT), D De Marchi (Pisa,IT), G Todiere (Pisa,IT), F Fulgenzi (Chieti,IT), Y Ghebru (Chieti,IT), S Guiducci (Florence,IT), R De Caterina (Pisa,IT), M Matucci Cerinic (Florence,IT), L Gargani (Pisa,IT)

Authors:
A Pepe1 , A Meloni1 , C Bruni2 , D De Marchi1 , G Todiere1 , F Fulgenzi3 , Y Ghebru3 , S Guiducci2 , R De Caterina4 , M Matucci Cerinic2 , L Gargani5 , 1Fondazione Toscana Gabriele Monasterio - Pisa - Italy , 2University of Florence - Florence - Italy , 3University of Chieti-Pescara - Chieti - Italy , 4University of Pisa - Pisa - Italy , 5Institute of Clinical Physiology, CNR - Pisa - Italy ,

Citation:
European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii81

Background: Cardiac involvement, often subclinical, is frequent in patients with systemic sclerosis (SS), and significantly affects prognosis. Cardiac magnetic resonance (CMR) is the non-invasive gold standard to quantify biventricular functional parameters and to allow myocardial tissue characterization.

Purpose: To evaluate the prognostic value of CMR for cardiac events in SS.

Methods: Two hundred and seventy-three SS patients with a thorough clinical assessment underwent CMR imaging using a 1.5 T GE scanner. We quantified biventricular function parameter by steady-state free precession (SSFP) cine images, edema by short inversion time inversion recovery (STIR) T2 images, and macroscopic fibrosis by late gadolinium enhancement (LGE). Patients were followed-up for subsequent cardiac events, including new-onset pulmonary arterial hypertension (PAH), new-onset heart failure (HF), and new-onset severe arrhythmias (sustained ventricular tachycardia or fibrillation).

Results: The mean follow-up was 23.9 ± 17.0 months. During follow-up, a total of 14 cardiac events occurred in 14 different patients (3 new-onset PAH, 5 new-onset HF, 6 ventricular tachycardias). CMR predictors of cardiac events at univariate analysis were left and right ventricular ejection fractions, indexed left and right atrial areas, and LGE (see Table). Myocardial fibrosis by LGE was the only independent predictor at multivariate analysis (hazard ratio 3.175; 95% C.I. 1.021-9.870, see Figure).

Conclusions: Cardiac magnetic resonance anatomical and functional parameters of both the left and right heart have significant prognostic value in patients with SS.

Univariate analysis Multivariate analysis

HR (95% CI)

P

HR (95% CI)

P
Left Ventricular Ejection Fraction 0.904 (0.843 - 0.969) 0.004 0.935 (0.868 - 1.007) 0.075
Indexed Left Atrial Area 1.244 (1.002 - 1.546) 0.048
Right Ventricular Ejection Fraction 0.926 (0.884 - 0.969) 0.001 0.958 (0.904 - 1.014) 0.139
Indexed Right Atrial Area 1.384 (1.059 - 1.809) 0.017
Right Ventricular End-Diastolic Mass 1.039 (0.991 - 1.091) 0.115
Right Ventricular End-Systolic Mass 1.036 (0.988 - 1.086) 0.148
T2 ratio 0.247 (0.019 - 3.251) 0.288
Late Gadolinium Enhancement 3.871 (1.289 - 11.623) 0.016 3.175 (1.021-9.870) 0.046

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