title: Characteristics and clinical relevance of late gadolinium enhancement in cardiac magnetic resonance in patients with systemic sclerosis.
abstract: Cardiac involvement in systemic sclerosis (SSc) is considerably frequent in autopsy, but the early identification is clinically difficult. Recent advantages in cardiac magnetic resonance (CMR) enabled to detect myocardial fibrotic scar as late gadolinium enhancement (LGE). We aimed to examine the prevalence and distribution of LGE in patients with SSc, and associate them with clinical features, electrocardiographic abnormalities and cardiac function. Forty patients with SSc (58 ± 14 years-old, 35 females, limited/diffuse 25/15, disease duration 106 ± 113 months) underwent serological tests, 12-lead electrocardiogram (ECG) and CMR. Seven patients (17.5 %) showed LGE in 26 segments of left ventricle (LV). LGE distributed mainly in the basal to mid inter-ventricular septum and the right ventricular (RV) insertion points, but involved all the myocardial regions. More patients with LGE showed NYHA functional class II and more (71 vs. 21 %, p < 0.05), bundle branch blocks (57 vs. 6 %, p < 0.05), LV ejection fraction (LVEF) < 50 % (72 vs. 6 %, p < 0.01), LV asynergy (43 vs. 0 %, p < 0.01) and RVEF < 40 % (100 vs. 39 %, p < 0.01). There was no difference in disease duration, disease types, or prevalence of positive autoimmune antibodies or high serum NT-proBNP level (>125 pg/ml). When cardiac involvement of SSc was defined as low LVEF, ECG abnormalities or high NT-proBNP, the sensitivity, specificity positive and negative predictive values of LGE were 36, 92, 71 and 72 %, respectively. We could clarify the prevalence and distribution of LGE in Japanese patients with SSc. The presence of LGE was associated with cardiac symptom, conduction disturbance and impaired LV/RV contraction.
authors.affiliation: Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Sano
authors.affiliation: Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan. satoh36@hama-med.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Satoh
authors.affiliation: Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Suwa
authors.affiliation: Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Nobuhara
authors.affiliation: Department of Emergency Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Takeji
authors.initials: T
authors.lastname: Saitoh
authors.affiliation: Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Saotome
authors.affiliation: Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Urushida
authors.affiliation: Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Katoh
authors.affiliation: Division of Immunology and Rheumatology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Kumiko
authors.initials: K
authors.lastname: Shimoyama
authors.affiliation: Division of Immunology and Rheumatology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Suzuki
authors.affiliation: Division of Immunology and Rheumatology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Noriyoshi
authors.initials: N
authors.lastname: Ogawa
authors.affiliation: Department of Radiology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Takehara
authors.affiliation: Department of Radiology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Harumi
authors.initials: H
authors.lastname: Sakahara
authors.affiliation: Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan.
authors.forename: Hideharu
authors.initials: H
authors.lastname: Hayashi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000175:diagnosis*; D003287:Contrast Media; D004562:Electrocardiography; D005260:Female; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D012595:Scleroderma, Systemic / Q000150:complications*; D016277:Ventricular Function, Left; D055815:Young Adult
chemical_list: D003287:Contrast Media; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D005682:Gadolinium
keywords: Cardiac function; Conduction disturbance; Electrocardiography; Late gadolinium enhancement; Systemic scleroderma