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. 2009 Dec;68(12):1878-84.
doi: 10.1136/ard.2008.095836. Epub 2008 Dec 3.

Cardiac magnetic resonance imaging in systemic sclerosis: a cross-sectional observational study of 52 patients

A-L Hachulla  1 , D Launay, V Gaxotte, P de Groote, N Lamblin, P Devos, P-Y Hatron, J-P Beregi, E Hachulla
Affiliations

Cardiac magnetic resonance imaging in systemic sclerosis: a cross-sectional observational study of 52 patients

A-L Hachulla et al. Ann Rheum Dis. 2009 Dec.

Abstract

Objectives: To assess the prevalence and patterns of cardiac abnormalities as detected by cardiac magnetic resonance imaging (MRI) in systemic sclerosis (SSc).

Methods: Fifty-two consecutive patients with SSc underwent cardiac MRI to determine morphological, functional, perfusion at rest and delayed enhancement abnormalities.

Results: At least one abnormality on cardiac MRI was observed in 39/52 patients (75%). Increased myocardial signal intensity in T2 was observed in 6 patients (12%), thinning of left ventricle (LV) myocardium in 15 patients (29%) and pericardial effusion in 10 patients (19%). LV and right ventricle (RV) ejection fractions were altered in 12 patients (23%) and 11 patients (21%), respectively. LV diastolic dysfunction was found in 15/43 patients (35%). LV kinetic abnormalities were found in 16/52 patients (31%) and myocardial delayed contrast enhancement was detected in 11/52 patients (21%). No perfusion defects at rest were found. Patients with limited SSc had similar MRI abnormalities to patients with diffuse SSc. Seven of 40 patients (17%) without pulmonary arterial hypertension had RV dilatation.

Conclusions: This study shows that MRI is a reliable and sensitive technique for diagnosing heart involvement in SSc and for analysing its mechanisms, including its inflammatory, microvascular and fibrotic components. Compared with echocardiography, MRI appears to provide additional information by visualising myocardial fibrosis and inflammation. RV dilatation appeared to be non-specific for pulmonary arterial hypertension but could also reflect myocardial involvement related to SSc. Further studies are needed to determine whether cardiac MRI abnormalities have an impact on the prognosis and treatment strategy.

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Conflict of interest statement

Competing interests: None.

Figures

Figure 1
Figure 1
Frequencies of the main MRI abnormalities. LV, left ventricle; RV, right ventricle.
Figure 2
Figure 2
Anteroseptal and lateral (arrows) transmural nodular increased signal intensity in T2-weighted sequence on an MRI 1.5 Tesla scan (Intera, Philips Medical Systems, Best, The Netherlands).
Figure 3
Figure 3
Short axis of the right and left ventricle in cine-MRI sequence showing the thickness of the left ventricle myocardium (end-diastolic frame).
Figure 4
Figure 4
Mid-wall linear late enhancement (arrows) in anteroseptal location assessed by delayed enhancement sequence 10 min after Gd-DTPA injection on an MRI 1.5 Tesla scan. (A) Four chambers; (B) short axis; (C) long axis.
See this image and copyright information in PMC

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