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Cardiac calcium score in systemic sclerosis


Cardiac coronary Ca score (CCS), and extra coronary Ca score (ECCS) estimation in asymptomatic systemic sclerosis (SSc) patients and their relation to different disease and patients’ variables. The CCS and ECCS were estimated in asymptomatic 20 SSc patients compared to 20 age and sex-matched healthy control using non-contrast cardiac computed tomography. All were applied for cardiac history taking, examination, echocardiography, body mass index (BMI), complete blood picture, erythrocyte sedimentation rate, and lipid profile estimation. The SSc patients were 11 females and 9 males with a mean age of (42.55 ± 9.145) and mean disease duration (12.9 ± 6.774). CCS was reported in 9 (45%) SSc cases and 2 (10%) of the control; (p = 0.013) and was significantly greater in SSc patients (58.4 ± 175.443) than in the control group (0.7 ± 2.25); (p = 0.01). The ECCS was significantly higher in SSc cases (194.45 ± 586.511) than control group (2.8 ± 7.8); (p = 0.001) and reported in 16 (80%) SSc cases and 3 (15%) of controls; (p = 0.000). Limited scleroderma cases had higher scores than diffuse type. Patients with total ca score (> 100) were older (p = 0.016), had longer disease duration (p = 0.001) and greater BMI (p = 0.002). Significant correlation was found between the log-transformed CCS and disease duration, age, BMI, left ventricular mass, and mass index. Systemic sclerosis patients are at increased risk of subclinical cardiovascular disease determined by cardiac Ca scoring as a noninvasive and reliable method. Extra coronary calcification may be an earlier indicator for this. Disease duration is a determinant risk factor for cardiac calcification in SSc.

Key Points

• Although the association between interleukin-6 (IL-6) promoter polymorphism and rheumatic arthritis (RA) has been discussed in the previous meta-analysis, their conclusions are inconsistent.

• Systemic sclerosis patients are at high risk of accelerated atherosclerosis and cardiovascular diseases. Coronary atherosclerosis was previously estimated in SSc patients through coronary angiography. A novel method of assessing coronary artery disease is the coronary calcium score, as determined by multidetector computed tomography, it measures coronary artery calcification that occurs in atherosclerotic plaque. In this study, the cardiac coronary and extra coronary Ca score were evaluated in relation to disease characteristics in asymptomatic SSC patients for early detection of coronary artery disease.

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Fig. 1

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.


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Authors and Affiliations



Naglaa Afifi: conceived the idea and planned the research work, data analysis, and manuscript writing. Maha Khalifa: contributing the design, performed part of investigations, and supervised the finding. Alaa Alah Mohamed verified the analytic methods and reviewed the manuscript. Hend Galal participated in writing the research, performed part of investigations, and supervised the work. All authors discussed the result and contributed to the final manuscript.

Corresponding author

Correspondence to Naglaa Afifi.

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Ethics approval

The study conforms to the 1995 Helsinki declaration and is approved by the research ethical committee, Faculty of Medicine, Ain Shams University FWA000017585 (No: FMASU R 13/2020).

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All patients included in this study gave written informed consent to participate in this research.

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Consent for publication was taken from all participants.

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The authors declare no competing interests.

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I would like to introduce our work for publication in your prestigious journal. the manuscript entitled “Cardiac calcium score in systemic sclerosis” I also declare that the material is original research that has not been previously published and it has obtained the required ethical approvals. It has been seen and approved by all the authors; they have given necessary attention to ensure the integrity of the work

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Afifi, N., Khalifa, M.M.M., Al Anany, A.A.M.M.M. et al. Cardiac calcium score in systemic sclerosis. Clin Rheumatol 41, 105–114 (2022).

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