MYOCARDIAL INVOLVEMENT DETECTED USING CARDIAC MAGNETIC RESONANCE IMAGING IN PATIENTS WITH SYSTEMIC SCLEROSIS – A PROSPECTIVE OBSERVATIONAL STUDY

Introduction and objectives: Cardiac involvement in systemic sclerosis (SSc) patients affects mortality. Cardiac magnetic resonance (CMR) is capable of detecting structural changes, includ-ing diffuse myocardial fibrosis that may develop over time. Our aim was to evaluate myocardial structure and function changes using CMR in patients with SSc without known cardiac disease during a 5-year follow-up and find possible correlations with selected biomarkers. Methods: A total of 25 patients underwent baseline and follow-up CMR examinations according to a pre-specified protocol. Standard biochemistry, five biomarkers (hsTnI, NT-proBNP, Galectin-3, sST2, and GDF-15), and disease-specific functional parameters enabling classification of disease severity were also measured. Results: After five years, no patient suffered from manifest heart disease. Mean extracellular volume (ECV) and T1 mapping values did not change significantly (P ≥ 0.073). However, individual increases in native T1 time and ECV correlated with increased Ga-lectin-3 serum levels (r = 0.56; P = 0.0050, and r = 0.71; P = 0.0001, respectively). Progression of skin involvement assessed using Rodnan skin score and a decrease in diffusing capacity of the lungs were associated with increased GDF-15 values (r = 0.63; P = 0.0009, and r = −0.51; P = 0.011, respectively). Conclusions: During the 5-year follow-up, there was no new onset of heart disease observed in patients with SSc. However, in some patients, CMR detected progression of sub-clinical cardiac fibrosis that significantly correlated with elevated Galectin-3 levels. GDF-15 values were found to be associated with disease severity progression.