title: Assessment of myocardial fibrosis and microvascular damage in systemic sclerosis by magnetic resonance imaging and coronary angiotomography.
abstract: OBJECTIVE
  Cardiac involvement in SSc is characterized by myocardial fibrosis, arrhythmias and pericarditis. Prevalence studies have shown variable results. The objective of this study was to determine the prevalence of cardiac involvement in SSc patients using the non-invasive, highly sensitive diagnostic methods of cardiac MRI and coronary angiotomography.
  
  
  METHODS
  We included 62 SSc patients and excluded those with heart disease prior to the onset of SSc, renal failure, diabetes mellitus, hyperlipidaemia, arterial hypertension, untreated thyroid disease, cor pulmonale, pregnancy or contraindications to performing cardiac MRI. All underwent clinical and laboratory evaluation, ECG, coronary angiotomography and cardiac MRI.
  
  
  RESULTS
  The prevalence of myocardial fibrosis was 45% and was higher in dcSSc (59%) than in lcSSc patients (33%; P = 0.04). The mean left ventricular ejection fraction (LVEF) was lower in patients with myocardial fibrosis (56%) than in those without fibrosis (63%; P = 0.0009); myocardial fibrosis on MRI was more frequent in the basal-septal segments of the LV. Seventy-nine per cent of patients had subendocardial perfusion defects and these were associated with higher ultrasensitive serum CRP values. There was no association of myocardial fibrosis or microvascular damage with atherosclerosis.
  
  
  CONCLUSIONS
  The prevalence of myocardial fibrosis on MRI attributable to SSc is 45%, is more frequent and severe in dcSSc patients, is associated with lower LVEF and affects mainly basal LV walls. Microvascular damage in SSc is common and is associated with elevated ultrasensitive CRP levels. Cardiac damage due to SSc is not associated with coronary artery disease.
authors.affiliation: Department of Immunology and Rheumatology, Department of Radiology, Department of Cardiology and Emergency Department, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico. sofarodriguez@yahoo.com.mx.
authors.forename: Tatiana S
authors.initials: TS
authors.lastname: Rodríguez-Reyna
authors.affiliation: Department of Immunology and Rheumatology, Department of Radiology, Department of Cardiology and Emergency Department, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico.
authors.forename: Martha
authors.initials: M
authors.lastname: Morelos-Guzman
authors.affiliation: Department of Immunology and Rheumatology, Department of Radiology, Department of Cardiology and Emergency Department, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico.
authors.forename: Pablo
authors.initials: P
authors.lastname: Hernández-Reyes
authors.affiliation: Department of Immunology and Rheumatology, Department of Radiology, Department of Cardiology and Emergency Department, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico.
authors.forename: Karla
authors.initials: K
authors.lastname: Montero-Duarte
authors.affiliation: Department of Immunology and Rheumatology, Department of Radiology, Department of Cardiology and Emergency Department, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Martínez-Reyes
authors.affiliation: Department of Immunology and Rheumatology, Department of Radiology, Department of Cardiology and Emergency Department, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico.
authors.forename: Carlos
authors.initials: C
authors.lastname: Reyes-Utrera
authors.affiliation: Department of Immunology and Rheumatology, Department of Radiology, Department of Cardiology and Emergency Department, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico.
authors.forename: Jorge
authors.initials: J
authors.lastname: Vazquez-La Madrid
authors.affiliation: Department of Immunology and Rheumatology, Department of Radiology, Department of Cardiology and Emergency Department, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico.
authors.forename: Jaime
authors.initials: J
authors.lastname: Morales-Blanhir
authors.affiliation: Department of Immunology and Rheumatology, Department of Radiology, Department of Cardiology and Emergency Department, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico.
authors.forename: Carlos
authors.initials: C
authors.lastname: Núñez-Álvarez
authors.affiliation: Department of Immunology and Rheumatology, Department of Radiology, Department of Cardiology and Emergency Department, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico.
authors.forename: Javier
authors.initials: J
authors.lastname: Cabiedes-Contreras
mesh_terms: D000328:Adult; D057791:Cardiac Imaging Techniques; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D005260:Female; D005355:Fibrosis; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D055806:Microvessels / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D009206:Myocardium / Q000473:pathology*; D045743:Scleroderma, Diffuse / Q000150:complications / Q000175:diagnosis*; D045745:Scleroderma, Limited / Q000150:complications / Q000175:diagnosis*; D012595:Scleroderma, Systemic / Q000150:complications / Q000175:diagnosis; D013318:Stroke Volume; D014057:Tomography, X-Ray Computed
keywords: atherosclerosis; coronary angiotomography; coronary artery disease; magnetic resonance image; microvascular damage; myocardial fibrosis; scleroderma