title: Cardiac magnetic resonance imaging with pharmacological stress perfusion and delayed enhancement in asymptomatic patients with systemic sclerosis.
abstract: OBJECTIVE
  To assess cardiac involvement in asymptomatic patients with systemic sclerosis (SSc) by cardiac magnetic resonance imaging (MRI).
  
  
  METHODS
  Ten asymptomatic patients with SSc (all female; mean age 59.5+/-9.4 yrs) underwent contrast enhanced cardiac MRI on a 1.5 T MRI device. Adenosine triphosphate was used for stress and rest perfusion to assess perfusion defects due to microvascular impairment or ischemia, and delayed enhanced (DE) imaging was obtained for the assessment of myocardial necrosis and fibrosis. We evaluated the pathophysiological associations of stress perfusion combined with DE imaging with SSc disease severity measures.
  
  
  RESULTS
  Stress perfusion defects were seen in 5 out of 9 patients (56%): 4 had nonsegmental subendocardial perfusion defects and one had a segmental subendocardial perfusion defect. Three patients were found to have DE. DE was not observed in any patient without perfusion defect; and among the 5 patients with perfusion defects, 3 (60%) had DE. Two of the 3 had DE in segments not matching the region of nonsegmental perfusion defects. The remaining one had a segmental subendocardial DE matching the region of a segmental perfusion defect. Perfusion defects were seen in 75% of patients with a history of digital ulceration compared to only 20% of those without history of ulceration.
  
  
  CONCLUSIONS
  Subclinical myocardial involvement, as detected by cardiac MRI, was frequent in asymptomatic patients with SSc. Cardiac MRI may aid in understanding the pathophysiological mechanism of SSc.
authors.affiliation: Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 4100, Baltimore, MD 21224, USA. hkobaya6@jhmi.edu
authors.forename: Hitomi
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Isamu
authors.initials: I
authors.lastname: Yokoe
authors.forename: Masaharu
authors.initials: M
authors.lastname: Hirano
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Nakamura
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Nakajima
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Fontaine
authors.forename: Jon T
authors.initials: JT
authors.lastname: Giles
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kobayashi
mesh_terms: D000255:Adenosine Triphosphate; D000368:Aged; D000465:Algorithms; D005080:Exercise Test / Q000379:methods*; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology* / Q000473:pathology* / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology; D010865:Pilot Projects; D012595:Scleroderma, Systemic / Q000150:complications* / Q000473:pathology* / Q000503:physiopathology
chemical_list: D000255:Adenosine Triphosphate; D019786:Gadolinium DTPA