Pharmacological stress, rest perfusion and delayed enhancement cardiac magnetic resonance identifies very early cardiac involvement in systemic sclerosis patients of recent onset
Corresponding Author
Roberto Giacomelli
Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, Italy
Correspondence: Roberto Giacomelli, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Rheumatology Unit, delta 6 building, L'Aquila, PO box 67100, Italy. Email: [email protected]Search for more papers by this authorErnesto Di Cesare
Department of Biotechnological and Applied Clinical Sciences, Division of Cardiac Radiology, Laboratory of Radiobiology, University of L'Aquila, L'Aquila, Italy
Search for more papers by this authorPaola Cipriani
Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, Italy
Search for more papers by this authorPiero Ruscitti
Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, Italy
Search for more papers by this authorAlessandra Di Sibio
Department of Biotechnological and Applied Clinical Sciences, Division of Radiology, Laboratory of Radiobiology, University of L'Aquila, L'Aquila, Italy
Search for more papers by this authorVasiliki Liakouli
Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, Italy
Search for more papers by this authorAntonio Gennarelli
Department of Biotechnological and Applied Clinical Sciences, Division of Radiology, Laboratory of Radiobiology, University of L'Aquila, L'Aquila, Italy
Search for more papers by this authorFrancesco Carubbi
Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, Italy
Search for more papers by this authorAlessandra Splendiani
Department of Biotechnological and Applied Clinical Sciences, Division of Radiology, Laboratory of Radiobiology, University of L'Aquila, L'Aquila, Italy
Search for more papers by this authorOnorina Berardicurti
Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, Italy
Search for more papers by this authorPaola Di Benedetto
Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, Italy
Search for more papers by this authorFrancesco Ciccia
Division of Rheumatology, Department of Internal Medicine, University of Palermo, Palermo, Italy
Search for more papers by this authorGiuliana Guggino
Division of Rheumatology, Department of Internal Medicine, University of Palermo, Palermo, Italy
Search for more papers by this authorGanna Radchenko
Institute of Cardiology of Ukrainian National Academy of Medical Science, Kyiv, Ukraine
Search for more papers by this authorGiovanni Triolo
Division of Rheumatology, Department of Internal Medicine, University of Palermo, Palermo, Italy
Search for more papers by this authorCarlo Masciocchi
Department of Biotechnological and Applied Clinical Sciences, Division of Radiology, Laboratory of Radiobiology, University of L'Aquila, L'Aquila, Italy
Search for more papers by this authorCorresponding Author
Roberto Giacomelli
Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, Italy
Correspondence: Roberto Giacomelli, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Rheumatology Unit, delta 6 building, L'Aquila, PO box 67100, Italy. Email: [email protected]Search for more papers by this authorErnesto Di Cesare
Department of Biotechnological and Applied Clinical Sciences, Division of Cardiac Radiology, Laboratory of Radiobiology, University of L'Aquila, L'Aquila, Italy
Search for more papers by this authorPaola Cipriani
Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, Italy
Search for more papers by this authorPiero Ruscitti
Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, Italy
Search for more papers by this authorAlessandra Di Sibio
Department of Biotechnological and Applied Clinical Sciences, Division of Radiology, Laboratory of Radiobiology, University of L'Aquila, L'Aquila, Italy
Search for more papers by this authorVasiliki Liakouli
Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, Italy
Search for more papers by this authorAntonio Gennarelli
Department of Biotechnological and Applied Clinical Sciences, Division of Radiology, Laboratory of Radiobiology, University of L'Aquila, L'Aquila, Italy
Search for more papers by this authorFrancesco Carubbi
Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, Italy
Search for more papers by this authorAlessandra Splendiani
Department of Biotechnological and Applied Clinical Sciences, Division of Radiology, Laboratory of Radiobiology, University of L'Aquila, L'Aquila, Italy
Search for more papers by this authorOnorina Berardicurti
Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, Italy
Search for more papers by this authorPaola Di Benedetto
Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, Italy
Search for more papers by this authorFrancesco Ciccia
Division of Rheumatology, Department of Internal Medicine, University of Palermo, Palermo, Italy
Search for more papers by this authorGiuliana Guggino
Division of Rheumatology, Department of Internal Medicine, University of Palermo, Palermo, Italy
Search for more papers by this authorGanna Radchenko
Institute of Cardiology of Ukrainian National Academy of Medical Science, Kyiv, Ukraine
Search for more papers by this authorGiovanni Triolo
Division of Rheumatology, Department of Internal Medicine, University of Palermo, Palermo, Italy
Search for more papers by this authorCarlo Masciocchi
Department of Biotechnological and Applied Clinical Sciences, Division of Radiology, Laboratory of Radiobiology, University of L'Aquila, L'Aquila, Italy
Search for more papers by this authorAbstract
Objective
To evaluate occult cardiac involvement in asymptomatic systemic sclerosis (SSc) patients by pharmacological stress, rest perfusion and delayed enhancement cardiac magnetic resonance (CMR), for a very early identification of patients at higher risk of cardiac-related mortality.
Methods
Sixteen consecutive patients with definite SSc, fulfilling the American College of Rheumatology/European League Against Rheumatism 2013 classification criteria in less than 1 year from the onset of Raynaud's phenomenon, underwent pharmacological stress, rest perfusion and delayed enhancement CMR. At enrollment, no patient showed signs and/or symptoms suggestive for cardiac involvement. No patient showed traditional cardiovascular risk factors. Both the 12-lead electrocardiogram examination and echocardiographic evaluation did not show any alterations in our cohort.
Results
Stress perfusion defects of left ventricle were detected in six out of 16 (37.5%) patients and these defects did not match with the coronary flow distribution. The results showed the presence of two different patterns of stress perfusion defects: sub-endocardial and/or a midmyocardial. The presence of stress perfusion defects did not correlate with any clinical feature of enrolled patients.
Conclusion
Myocardial stress perfusion defects may be detected early by pharmacological stress perfusion CMR, a reliable and sensitive technique for the noninvasive evaluation of SSc heart disease, in patients with SSc of recent onset. These defects seem to be independent from traditional risk factors and associated comorbidities, suggesting they are a specific hallmark of the disease.
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