Abstract
Introduction and objectives: Cardiac involvement in systemic sclerosis (SSc) patients affects mortality. Cardiac magnetic resonance (CMR) is capable of detecting structural changes, including diffuse myocardial fibrosis that may develop over time. Our aim was to evaluate myocardial structure and function changes using CMR in patients with SSc without known cardiac disease during a 5-year follow-up and find possible correlations with selected biomarkers. Methods: A total of 25 patients underwent baseline and follow-up CMR examinations according to a pre-specified protocol. Standard biochemistry, five biomarkers (hsTnI, NT-proBNP, galectin-3, sST2, and GDF-15), and disease-specific functional parameters enabling the classification of disease severity were also measured. Results: After five years, no patient suffered from manifest heart disease. Mean extracellular volume (ECV) and T1 mapping values did not change significantly (p ≥ 0.073). However, individual increases in native T1 time and ECV correlated with increased galectin-3 serum levels (r = 0.56; p = 0.0050, and r = 0.71; p = 0.0001, respectively). The progression of skin involvement assessed using the Rodnan skin score and a decrease in the diffusing capacity of the lungs were associated with increased GDF-15 values (r = 0.63; p = 0.0009, and r = −0.51; p = 0.011, respectively). Conclusions: During the 5-year follow-up, there was no new onset of heart disease observed in patients with SSc. However, in some patients, CMR detected progression of sub-clinical myocardial fibrosis that significantly correlated with elevated galectin-3 levels. GDF-15 values were found to be associated with disease severity progression.
Highlights
Systemic sclerosis (SSc) is an immune-mediated rheumatic disease characterized by excessive extracellular matrix deposition, widespread fibrosis of the skin and visceral organs, microvascular injury, and immune system activation [1]
Changes in High-sensitivity cardiac troponin I (hsTnI), NT-proBNP, or Suppression of tumorigenicity2 (sST2) were not significantly related to changes in any of the monitored Cardiac magnetic resonance (CMR) parameters or clinical examinations
Deterioration of CMR parameters associated with fibrosis development correlated with an increase in serum galectin-3 levels
Summary
SSc can affect any cardiac structure, causing myocardial abnormalities such as myocardial fibrosis, myocardial microvascular ischemia, pericarditis, pericardial effusion, and less commonly, valvular disease. These may be clinically manifested by left ventricular systolic or diastolic dysfunction and bradyarrhythmias or tachyarrhythmias. Primary cardiac involvement is difficult to assess accurately for a variety of reasons. These reasons include the long asymptomatic course of the disease, various nonspecific symptoms associated with cardiac manifestations, the accuracy of the diagnostic method used, and the choice of defining criteria to characterize the disease [3,4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
