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Myocardial perfusion defects in scleroderma detected by contrast-enhanced cardiovascular magnetic resonance

La radiologia medica volume 119, pages 885–894 (2014)Cite this article

An Erratum to this article was published on 15 July 2014

Abstract

Purpose

The authors investigated whether contrast-enhanced cardiovascular magnetic resonance (CMR) imaging may be used to detect early cardiac involvement in patients with systemic sclerosis (SSc).

Materials and methods

Twenty-six SSc patients (nine with diffuse cutaneous SSc and 17 with limited cutaneous SSc) and 13 sex- and age-matched healthy controls (HC) were studied. Contrast-enhanced CMR allowed the analysis of first-pass images (areas of hypo-enhancement indicating perfusion defects) and delayed images (persistent hyper-enhancement indicating fibrosis). Clinical variables including disease duration and presence of major visceral complications of SSc were investigated in each patient.

Results

Perfusion defects were detected in 53.8 % of SSc patients but in none of the HC. Perfusion abnormalities were detected in 28.6 % of SSc patients with disease duration less than 2 years and in 29.2 % of asymptomatic SSc patients. Delayed contrast enhancement was present in 25 % of SSc patients but not in HC. All patients with delayed contrast enhancement showed first-pass hypoperfusion. Right ventricular wall thickness was significantly increased in all SSc patients when compared to HC (p < 0.001); a similar trend was observed when SSc patients without pulmonary arterial hypertension were analysed (p < 0.04). A trend to lower end-diastolic and end-systolic right ventricular volumes in SSc versus HC was observed (p < 0.05 and p < 0.04, respectively).

Conclusions

Myocardial hypoperfusion is common in SSc and occurs early in the course of the disease. Co-localisation of perfusion defects and delayed contrast enhancement indicative of fibrosis suggests that myocardial hypoxia may play a role in the pathogenesis of myocardial fibrosis.

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Acknowledgments

This study was supported by grants from Fondazione Italiana Ricerca Artrite (FIRA) and Ministero Italiano per l’Università e la Ricerca Scientifica (MIUR) to A.G., and from Fondazione di Medicina Molecolare e Terapia Cellulare, Università Politecnica delle Marche, Ancona, Italy.

Conflict of interest

N. Schicchi, G. Valeri, G. Moroncini, G. Agliata, L. Salvolini, A. Gabrielli and A. Giovagnoni declare that they have no conflict of interest.

Ethical statement

The research was carried out in compliance with the Helsinky Declaration. The study was approved by the Institutional Ethics Committee of Azienda Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy, and informed consent was obtained from all subjects participating in this study.

Author information

Affiliations

  1. Radiologia Pediatrica e Specialistica, Azienda Ospedaliero Universitaria, Ospedali Riuniti di Ancona, Via Conca 71, 60126, Torrette, Ancona, Italy

    Nicolò Schicchi & Andrea Giovagnoni

  2. Clinica di Radiologia, d’Urgenza e dell’Area Oncologica, Ospedali Riuniti Ancona, Ancona, Italy

    Gianluca Valeri

  3. Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy

    Gianluca Moroncini & Armando Gabrielli

  4. Clinica Medica, Ospedali Riuniti Ancona, Ancona, Italy

    Gianluca Moroncini & Armando Gabrielli

  5. Scuola di Specializzazione in Radiodiagnostica, Università Politecnica delle Marche, Ancona, Italy

    Giacomo Agliata

  6. Clinica di Radiologia, d’Urgenza e dell’Area Oncologica, Azienda Ospedaliero Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy

    Luca Salvolini

Authors
  1. Nicolò Schicchi
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  2. Gianluca Valeri
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  3. Gianluca Moroncini
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  4. Giacomo Agliata
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  5. Luca Salvolini
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  6. Armando Gabrielli
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  7. Andrea Giovagnoni
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Correspondence to Nicolò Schicchi.

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Schicchi, N., Valeri, G., Moroncini, G. et al. Myocardial perfusion defects in scleroderma detected by contrast-enhanced cardiovascular magnetic resonance. Radiol med 119, 885–894 (2014). https://doi.org/10.1007/s11547-014-0419-7

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  • DOI: https://doi.org/10.1007/s11547-014-0419-7

Keywords

  • Contrast-enhanced cardiac MRI
  • Scleroderma