title: Myocardial perfusion defects in scleroderma detected by contrast-enhanced cardiovascular magnetic resonance.
abstract: OBJECTIVE
  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).
  
  
  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.
authors.affiliation: Radiologia Pediatrica e Specialistica, Azienda Ospedaliero Universitaria, Ospedali Riuniti di Ancona, Via Conca 71, 60126, Torrette, Ancona, Italy. schicchi.n@alice.it.
authors.forename: Nicolò
authors.initials: N
authors.lastname: Schicchi
authors.affiliation: Clinica di Radiologia, d'Urgenza e dell'Area Oncologica, Ospedali Riuniti Ancona, Ancona, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Valeri
authors.affiliation: Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy.|Clinica Medica, Ospedali Riuniti Ancona, Ancona, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Moroncini
authors.affiliation: Scuola di Specializzazione in Radiodiagnostica, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Agliata
authors.affiliation: Clinica di Radiologia, d'Urgenza e dell'Area Oncologica, Azienda Ospedaliero Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Salvolini
authors.affiliation: Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy.|Clinica Medica, Ospedali Riuniti Ancona, Ancona, Italy.
authors.forename: Armando
authors.initials: A
authors.lastname: Gabrielli
authors.affiliation: Radiologia Pediatrica e Specialistica, Azienda Ospedaliero Universitaria, Ospedali Riuniti di Ancona, Via Conca 71, 60126, Torrette, Ancona, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Giovagnoni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000175:diagnosis / Q000209:etiology*; D002319:Cardiovascular System / Q000503:physiopathology; D003287:Contrast Media; D004562:Electrocardiography; D005260:Female; D005355:Fibrosis; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D045743:Scleroderma, Diffuse / Q000150:complications; D012595:Scleroderma, Systemic / Q000150:complications*
chemical_list: D003287:Contrast Media