Beneath the silence: multiparametric cardiac magnetic resonance reveals subclinical cardiac involvement in patients with systemic sclerosis

Presenting Author(s)

• 

  Camilla Vittoria Vita, MD

  MD
  Department of Radiological and Hematological Sciences, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Radiology, Mayo Clinic, Rochester MN USA
  Rome, Lazio, Italy

Primary Author(s)

• 

  Camilla Vittoria Vita, MD

  MD
  Department of Radiological and Hematological Sciences, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Radiology, Mayo Clinic, Rochester MN USA
  Rome, Lazio, Italy

Co-Author(s)

• 

  Alessio Perazzolo, MD

  Radiologist
  Università Cattolica del Sacro Cuore, Rome Italy
  Rome, Lazio, Italy
• VS

  Vincenzo Scialo', MD

  Doctor, PhD student
  Humanitas Research Hospital; Department of Radiology, Mayo Clinic, Rochester MN USA
  Milan, Lombardia, Italy
• 

  Francesco Lauriero, MD

  Medical Doctor, Diagnostic Radiologist
  Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome (Italy)
  Rome, Lazio, Italy
• KW

  Kenneth J. Warrington, MD

  Rheumatologist
  Mayo Clinic, United States
• am

  ashima makol, MD

  Rheumatologist
  Mayo Clinic, United States
• JB

  Jacinta Browne, PhD

  Associate Professor
  Mayo Clinic, Department of Radiology, Minnesota, United States
• 

  Luigi Natale, MD

  Medical Doctor, Associate Professor of Radiology
  Catholic University - Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome (Italy)
  Rome, Lazio, Italy
• TL

  Tim Leiner, MD, PhD

  Professor of Radiology
  Mayo Clinic
  Rochester, Minnesota, United States

Background: Myocardial involvement in Systemic Sclerosis (SSc) is common and can significantly impact prognosis, yet it is frequently underdiagnosed due to its often-asymptomatic early presentation. CMR is the gold standard for non-invasive cardiac evaluation, offering comprehensive tissue characterization alongside functional and volumetric assessment. This study aimed to assess the role of CMR tissue characterization techniques—specifically native T1 and T2 mapping, ECV, and LGE—in detecting subclinical myocardial inflammation in patients with SSc.

Methods: A retrospective analysis was conducted on 26 patients with progressive SSc and no clinically apparent cardiac symptoms. CMR findings were correlated with clinical and laboratory data, including disease phenotype and stage, extent of skin fibrosis (modified Rodnan Skin Score), autoantibody profile, pulmonary function (Diffusing Capacity of the Lungs for Carbon Monoxide [DLCO]), and cardiac biomarkers (hs-cTn and NT-proBNP). Normality was assessed using the Shapiro-Wilk test. Depending on distribution and variable type, statistical comparisons included t-tests, Mann-Whitney U, ANOVA, Kruskal-Wallis, chi-square, as well as Pearson and Spearman correlation analyses. Given the exploratory aim of the study, statistical significance was assessed at a p value of 0.05 without multiple testing correction.

Results: CMR revealed elevated native T1 values in 69% (18/26), abnormal T2 mapping in 47% (9/19), increased ECV in 91% (21/23), and presence of LGE in 36% (9/25), indicating diffuse myocardial fibrosis and/or edema despite the absence of overt cardiac symptoms. Native T1 values differed significantly across SSc phenotypes (p = 0.0389), with the diffuse cutaneous subtype showing the highest median T1. Troponin-positive patients exhibited significantly higher native T1 (p = 0.0157), T2 (p = 0.0350), and ECV values (p = 0.0146). Native T1 was also correlated with reduced DLCO (p = 0.049), suggesting a link between myocardial fibrosis and pulmonary involvement.

Conclusion: Multiparametric CMR tissue characterization reveals a high prevalence of occult myocardial abnormalities in asymptomatic SSc patients. Native T1 and T2 mapping, even without contrast, serve as early markers of diffuse myocardial damage. These findings may inform future screening algorithms incorporating clinical and serologic indicators to identify patients who could benefit from early CMR evaluation.

Multiparametric CMR reveals frequent occult myocardial abnormalities in asymptomatic SSc patients, with significant correlations to phenotype and hs-cTn status.