MRI unveils hidden cardiac disease in patients with systemic sclerosis

Cardiac MR imaging with delayed gadolinium enhancement can detect silent myocardial fibrosis and other cardiac abnormalities in patients with systemic sclerosis, German researchers told attendees of a cardiac session in Vienna.

Systemic sclerosis affects mostly connective tissue and blood vessels of the skin. It can also involve internal organs such as the lungs, kidneys, and heart. The condition is not curable but can be treated. Because it can be hard to diagnose, however, prognosis is almost always poor in the case of heart involvement.

Principal investigator Dr. Frank Breuckmann and colleagues at the University of Duisburg-Essen enrolled 34 patients with proven systemic sclerosis and a control group matched for age, sex, and cardiovascular risk factors. All subjects underwent cine, steady-state free precession, T2-weighted, and inversion recovery sequence imaging after gadolinium injection for myocardial late enhancement.

The researchers found that a high proportion of patients with systemic fibrosis develop cardiac abnormalities, based on late enhancement patterns. They also found that the test can detect myocardial fibrosis in vivo.

Late gadolinium-enhanced MRI detected cardiac abnormalities in 50% of the systemic sclerosis patients and 24% of the control group. The technique correlated signs of myocardial fibrosis, pericardial effusion, and reduced ejection fraction in vivo in about one-fifth of patients and valvular pathologies in almost one-third. Late gadolinium enhancement correlated with signs of pericardial effusion and valvular pathologies in only 3% and 12% of subjects in the control group, respectively.

Results demonstrated a high frequency of abnormal cardiac MRI findings in systemic sclerosis patients and the ability of contrast-enhanced MRI to detect myocardial fibrosis in vivo, Breuckmann said.

"Contrast-enhanced MRI is suitable for the screening of cardiac involvement in asymptomatic patients," he said. "The test could also be used for detection and monitoring of treatment of inflammatory disease with antibiotic drugs."