PMID- 24593856 OWN - NLM STAT- MEDLINE DCOM- 20141021 LR - 20240117 IS - 1532-429X (Electronic) IS - 1097-6647 (Print) IS - 1097-6647 (Linking) VI - 16 IP - 1 DP - 2014 Mar 4 TI - Subclinical myocardial inflammation and diffuse fibrosis are common in systemic sclerosis--a clinical study using myocardial T1-mapping and extracellular volume quantification. PG - 21 LID - 10.1186/1532-429X-16-21 [doi] AB - BACKGROUND: Systemic sclerosis (SSc) is characterised by multi-organ tissue fibrosis including the myocardium. Diffuse myocardial fibrosis can be detected non-invasively by T1 and extracellular volume (ECV) quantification, while focal myocardial inflammation and fibrosis may be detected by T2-weighted and late gadolinium enhancement (LGE), respectively, using cardiovascular magnetic resonance (CMR). We hypothesised that multiparametric CMR can detect subclinical myocardial involvement in patients with SSc. METHODS: 19 SSc patients (18 female, mean age 55 +/- 10 years) and 20 controls (19 female, mean age 56 +/- 8 years) without overt cardiovascular disease underwent CMR at 1.5T, including cine, tagging, T1-mapping, T2-weighted, LGE imaging and ECV quantification. RESULTS: Focal fibrosis on LGE was found in 10 SSc patients (53%) but none of controls. SSc patients also had areas of myocardial oedema on T2-weighted imaging (median 13 vs. 0% in controls). SSc patients had significantly higher native myocardial T1 values (1007 +/- 29 vs. 958 +/- 20 ms, p < 0.001), larger areas of myocardial involvement by native T1 >990 ms (median 52 vs. 3% in controls) and expansion of ECV (35.4 +/- 4.8 vs. 27.6 +/- 2.5%, p < 0.001), likely representing a combination of low-grade inflammation and diffuse myocardial fibrosis. Regardless of any regional fibrosis, native T1 and ECV were significantly elevated in SSc and correlated with disease activity and severity. Although biventricular size and global function were preserved, there was impairment in the peak systolic circumferential strain (-16.8 +/- 1.6 vs. -18.6 +/- 1.0, p < 0.001) and peak diastolic strain rate (83 +/- 26 vs. 114 +/- 16 s-1, p < 0.001) in SSc, which inversely correlated with diffuse myocardial fibrosis indices. CONCLUSIONS: Cardiac involvement is common in SSc even in the absence of cardiac symptoms, and includes chronic myocardial inflammation as well as focal and diffuse myocardial fibrosis. Myocardial abnormalities detected on CMR were associated with impaired strain parameters, as well as disease activity and severity in SSc patients. CMR may be useful in future in the study of treatments aimed at preventing or reducing adverse myocardial processes in SSc. FAU - Ntusi, Ntobeko A B AU - Ntusi NA FAU - Piechnik, Stefan K AU - Piechnik SK FAU - Francis, Jane M AU - Francis JM FAU - Ferreira, Vanessa M AU - Ferreira VM FAU - Rai, Aitzaz B S AU - Rai AB FAU - Matthews, Paul M AU - Matthews PM FAU - Robson, Matthew D AU - Robson MD FAU - Moon, James AU - Moon J FAU - Wordsworth, Paul B AU - Wordsworth PB FAU - Neubauer, Stefan AU - Neubauer S FAU - Karamitsos, Theodoros D AU - Karamitsos TD AD - Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Level 0, John Radcliffe Hospital, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford OX3 9DU, United Kingdom. theo.karamitsos@cardiov.ox.ac.uk. LA - eng GR - 090532/Wellcome Trust/United Kingdom GR - BHF_/British Heart Foundation/United Kingdom PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't DEP - 20140304 PL - England TA - J Cardiovasc Magn Reson JT - Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance JID - 9815616 RN - 0 (Contrast Media) SB - IM MH - Aged MH - Cardiomyopathies/*diagnosis/etiology/pathology/physiopathology MH - Case-Control Studies MH - Contrast Media MH - Diastole MH - Edema, Cardiac/*diagnosis/etiology/pathology/physiopathology MH - England MH - Female MH - Fibrosis MH - Humans MH - *Magnetic Resonance Imaging, Cine MH - Male MH - Middle Aged MH - Myocarditis/*diagnosis/etiology/pathology/physiopathology MH - Myocardium/*pathology MH - Predictive Value of Tests MH - Prospective Studies MH - Scleroderma, Diffuse/*complications MH - Severity of Illness Index MH - Ventricular Function, Left MH - Ventricular Function, Right PMC - PMC3996013 EDAT- 2014/03/07 06:00 MHDA- 2014/10/22 06:00 PMCR- 2014/03/04 CRDT- 2014/03/06 06:00 PHST- 2013/11/11 00:00 [received] PHST- 2014/02/17 00:00 [accepted] PHST- 2014/03/06 06:00 [entrez] PHST- 2014/03/07 06:00 [pubmed] PHST- 2014/10/22 06:00 [medline] PHST- 2014/03/04 00:00 [pmc-release] AID - S1097-6647(23)00096-0 [pii] AID - 1532-429X-16-21 [pii] AID - 10.1186/1532-429X-16-21 [doi] PST - epublish SO - J Cardiovasc Magn Reson. 2014 Mar 4;16(1):21. doi: 10.1186/1532-429X-16-21.