Pseudo-infarction pattern in diffuse systemic sclerosis. Evaluation using cardiovascular magnetic resonance.
BACKGROUND
Diffuse systemic sclerosis (dSSc) is characterized by vascular lesions and fibrosis. Cardiac involvement, although silent, accounts for 36% of deaths. We hypothesized that cardiovascular magnetic resonance (CMR) can clarify the pathophysiology of Q waves in dSSc patients.


METHODS
105 dSSc, aged 48±2years, with atypical symptoms and normal routine assessment, were evaluated by ECG and CMR using a 1.5 T system. Biventricular function was assessed by steady-state free-precession sequence (SSFP). To identify fibrosis, late gadolinium enhanced areas (LGE) were evaluated 15min after injection of 0.2mmol/kg gadolinium-DTPA and expressed as % of LV mass.


RESULTS
Q waves in V1-V5 (Group A), II, III, AVF (Group B) and I, AVL, II, III, AVF, V1-V5 (Group C) were found in 25/105, 8/105 and 5/105 dSSc, respectively. In 25 dSSc with Q in V1-V6, patchy intramyocardial LGE was detected in 24/25 and involved 8±2% of LV mass. LGE involved the intraventricular septum (IVS) in 11/24 and the lateral wall (LAT) in 5/24 dSSc. Only in 1/25 dSSc, an anterior, transmural LGE, due to LAD occlusion, was identified. In 8 dSSc with Q in II, III, AVF, patchy intramyocardial LGE was detected in the inferior wall and involved 5±2% of LV mass. In 5 dSSc with Q in V1-V5, II, III, AVF, patchy intramyocardial LGE was detected in anterior and inferolateral wall and involved 9±2% of LV mass.


CONCLUSIONS
CMR unveiled that the pattern of myocardial fibrosis in dSSc with Q waves is due to the systemic disease and not to CAD.
Onassis Cardiac Surgery Center, Athens, Greece. Electronic address: soma13@otenet.gr.
Sophie
S
Mavrogeni
Navy Hospital, Athens, Greece.
Georgia
G
Karabela
Pathophysiology Dpt, Laikon Hospital, Athens, Greece.
Loukia
L
Koutsogeorgopoulou
Navy Hospital, Athens, Greece.
Efthymios
E
Stavropoulos
Navy Hospital, Athens, Greece.
Gikas
G
Katsifis
Pathophysiology Dpt, Laikon Hospital, Athens, Greece.
Sotiris C
SC
Plastiras
Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK.
George D
GD
Kitas
First Department of Propeudeutic and Internal medicine, Laikon Hospital, Athens University Medical School, Athens, Greece.
Stylianos
S
Panopoulos
First Department of Propeudeutic and Internal medicine, Laikon Hospital, Athens University Medical School, Athens, Greece.
George
G
Pentazos
Onassis Cardiac Surgery Center, Athens, Greece.
Eleni
E
Tzatzaki
Onassis Cardiac Surgery Center, Athens, Greece.
George
G
Markousis-Mavrogenis
Onassis Cardiac Surgery Center, Athens, Greece.
Genovefa
G
Kolovou
First Department of Propeudeutic and Internal medicine, Laikon Hospital, Athens University Medical School, Athens, Greece.
Petros P
PP
Sfikakis
D004562:Electrocardiography; D005260:Female; D005355:Fibrosis; D019786:Gadolinium DTPA / Q000378:metabolism; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D045743:Scleroderma, Diffuse / Q000150:complications*
D019786:Gadolinium DTPA
Cardiovascular magnetic resonance; ECG; Myocardial fibrosis; Scleroderma