Abstract
BackgroundMyocardial fibrosis is an important pathophysiologic mechanism of cardiac involvement that leads to increased mortality in patients with autoimmune diseases (AIDs). The aim of this study was to evaluate the association between myocardial strain from speckle-tracking echocardiography (STE) and fibrosis on cardiovascular magnetic resonance (CMR) and to further explore their prognostic implications in patients with AIDs.MethodsWe prospectively included 102 AIDs patients with clinically suspected cardiac involvement and 102 age- and sex-matched healthy individuals. Patients underwent CMR for evaluation of myocardial fibrosis by late gadolinium enhancement (LGE) and T1 mapping. A semiquantitative evaluation based on the extent of LGE was used to calculate the total (tLGEs) and segmental (sLGEs) LGE score. Global longitudinal strain (GLS) was evaluated by STE in all subjects. All patients were regularly followed up every 6 months. The primary endpoint was the composite incidence of all-cause death and cardiovascular hospitalization.ResultsCompared to healthy controls, AIDs patients had impaired GLS (−17.9 ± 5.1% vs. −21.2 ± 2.5%, p < 0.001). LGE was detected in 70% of patients. Patients with LGE presented worse GLS (−17.1 ± 5.3% vs. −19.6 ± 4.1%, p = 0.018) than those without LGE. On multivariate logistic analysis, GLS ≥ −15% was an independent predictor of LGE presence (OR = 4.98, 95%CI 1.35–18.33, p = 0.016). Moreover, a marked and stepwise impairment of segmental longitudinal strain (−19.3 ± 6.6 vs. −14.9 ± 6.5 vs. −8.9 ± 6.3, p < 0.001) was observed as sLGEs increased. During a median follow-up time of 25 months, 6 patients died, and 14 patients were hospitalized for cardiovascular reasons. Both GLS ≥ −15% (HR 3.56, 95%CI 1.28–9.86, p = 0.015) and tLGEs ≥ 6 (HR 4.13, 95%CI 1.43–11.92, p = 0.009) were independently associated with the primary endpoint.ConclusionsIn AIDs patients, impaired myocardial strain on STE could reflect the presence and extent of myocardial fibrosis and provide incremental prognostic value in addition to LGE in the prediction of adverse outcomes.
Highlights
Cardiac involvement is a common comorbidity of autoimmune diseases (AIDs) and leads to increased mortality not sufficiently explained by traditional cardiovascular risk factors [1–3]
Between 2011 and 2021, a prospective cohort of AIDs patients at the Peking Union Medical College Hospital was consecutively enrolled according to the following inclusion criteria: First, AIDs patients fulfilled the classification criteria of systemic lupus erythematosus (SLE) (ACR 1997 criteria) [12], idiopathic inflammatory myopathy (IIM) (Bohan and Peter criteria) [13], Sjogren’s syndrome (SS) (AECG 2002 criteria) [14], and SSc (ACR 1980 criteria) [15]; Second, patients with clinically suspected cardiac involvement who met indications for cardiovascular magnetic resonance (CMR), including new onset or persisting cardiac symptoms, electrocardiogram (ECG) abnormalities, or elevated troponin [16, 17]; Last, the interval of echocardiography and CMR imaging examinations was within 10 days
All patients had complete images for speckle-tracking echocardiography (STE) and late gadolinium enhancement (LGE) analyses, and CMR images of 90 patients were available for the analysis of T1 mapping
Summary
Cardiac involvement is a common comorbidity of autoimmune diseases (AIDs) and leads to increased mortality not sufficiently explained by traditional cardiovascular risk factors [1–3]. Despite the potential utility of the above imaging parameters in identifying cardiac involvement, the prognostic significance of myocardial impairment evidenced by imaging has not been well-studied [11] In this regard, our study aimed to assess imaging evidence of myocardial involvement in AIDs patients with clinically suspected cardiac involvement, explore the relationship of myocardial strain and fibrosis, and search for potential risk factors to predict prognosis. Myocardial fibrosis is an important pathophysiologic mechanism of cardiac involvement that leads to increased mortality in patients with autoimmune diseases (AIDs). The aim of this study was to evaluate the association between myocardial strain from speckle-tracking echocardiography (STE) and fibrosis on cardiovascular magnetic resonance (CMR) and to further explore their prognostic implications in patients with AIDs
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