Non-invasive diagnostic and functional evaluation of cardiac and pulmonary involvement in systemic sclerosis.
BACKGROUND
The aim of the present study was to evaluate the role of non-invasive methods in the early detection of pulmonary and cardiac involvement in Systemic sclerosis (SSc) and to identify clinical and/or instrumental patterns of prognostic value.


METHODS
Twenty female patients affected by SSc (8 with diffuse cutaneous SSc and 12 with limited cutaneous SSc) were enrolled in our study. Cardiac and pulmonary involvement (respiratory function tests and carbon monoxide lung diffusion [DLCO], chest radiography, high resolution computed tomography [HRCT] and lung perfusion magnetic resonance) were evaluated.


RESULTS
All 18 patients studied with respiratory function tests showed a significant reduction of DLCO. HRCT was considerably more sensitive than traditional chest radiography (59% versus 28%; p<0.05). Lung perfusion MRI revealed normal findings in 15 patients. Abnormal lung perfusion MRI results were found only in 3 patients. Angina pectoris with electrocardiographic and scintigraphic ischemic changes, severe regional wall motion abnormalities and complex arrhythmias seemed to be associated with poor prognosis.


CONCLUSIONS
Taken together these results indicate that a pulmonary involvement occurs both in limited and in diffuse cutaneous SSc patients and develops, in 83% of the cases, without any regional lung perfusion abnormality. Furthermore, cardiac involvement is detected in 65% of the cases as a consequence of a range of noxious events including myocardial ischemia, fibrosis and pressure overload which may result in ventricular dysfunction and arrhythmias. Lung perfusion MRI should be considered as a complementary diagnostic method for the functional evaluation of these symptoms in systemic sclerosis.
Sergiacomi
Gianluigi
G
Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Rome, Italy.
De Nardo
Domenico
D
Capria
Ambrogio
A
Manenti
Guglielmo
G
Fabiano
Sebastiano
S
Borzi
Mauro
M
De Sanctis
Giuliana
G
Konda
Daniel
D
Sperandio
Massimiliano
M
Schillaci
Orazio
O
Masala
Salvatore
S
Simonetti
Giovanni
G
Fontana
Luigi
L
D000328:Adult; D000368:Aged; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008168:Lung / Q000473:pathology / Q000503:physiopathology*; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D013902:Radiography, Thoracic; D012129:Respiratory Function Tests; D012595:Scleroderma, Systemic / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed