Early Detection of Cardiac Involvement in Systemic Sclerosis

Cardiac involvement in systemic sclerosis (SSc) is frequent and significantly affects the prognosis. Myocardial fibrosis is the pathological hallmark and has been reported in >50% of necropsies (1). Given the low sensitivity of transthoracic echocardiography (TTE) in detecting myocardial fibrosis, late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) is considered the noninvasive gold standard for imaging macroscopic myocardial fibrosis. Our aim was to evaluate the added value of LGE CMR to TTE in a large group of patients with SSc. A total of 201 patients with SSc (90.5% women; 51 14 years of age) without known SSc-related cardiac involvement were enrolled. All patients signed informed consent. All patients underwent comprehensive TTE with tissue Doppler imaging on the same day as 1.5-T LGE CMR with T1- and T2-weighted sequences. A standard 24-h Holter electrocardiogram (ECG) was recorded when clinically indicated; ventricular arrhythmias were defined by Lown classification grade $2.