Abstract：
Systemic sclerosis (SSc) is divided into diffuse and limited cutaneous SSc (dcSSc and lcSSc). The dcSSc subtype has more severe internal organ damage. This study aimed to assess whether cardiovascular magnetic resonance (CMR) parametric mapping could detect early cardiac involvement and evaluate differences between these two subtypes.
Eighty SSc patients (37 dcSSc and 43 lcSSc) underwent CMR at 3.0 T (Philips Healthcare, Best, The Netherlands) in our hospital between July 2018 and July 2021. We analyzed myocardial damage by CMR parametric mapping and compared it with clinical data.
The median duration of the disease was 10.2 months. The left ventricular ejection fraction was preserved in both groups. DcSSc had significantly higher native T1 (1333.4 ± 71.2 ms vs. 1295.0 ± 42.7 ms, p = 0.006) and extracellular volume fraction (32.6 ± 4.1 % vs. 30.3 ± 4.0 %, p = 0.018) in the mid-ventricular septum as compared to lcSSc, although there were no differences in T2 values. Native T1 values were positively correlated with the E/e\' ratio and left atrial volume indices evaluated by transthoracic echocardiography in overall SSc and dcSSc, but not in lcSSc. Logistic regression analysis revealed that native T1 was an independent predictor of left ventricular diastolic dysfunction in SSc patients (odds ratio, 1.194; 95 % confidence interval, 1.021-1.396; p = 0.026). Native T1 was higher in SSc patients with progressive skin lesions. Additionally, there were positive correlations between brain natriuretic peptide, New York Heart Association functional classification, and native T1.
CMR parametric mapping is a useful tool for detecting myocardial changes. Native T1 was the most sensitive parameter for identifying diffuse myocardial changes in the early stages of SSc and was associated with left ventricular diastolic function. DcSSc had more severe myocardial involvement than lcSSc; therefore, the use of CMR parametric mapping may aid in its prediction.
Eighty SSc patients (37 dcSSc and 43 lcSSc) underwent CMR at 3.0 T (Philips Healthcare, Best, The Netherlands) in our hospital between July 2018 and July 2021. We analyzed myocardial damage by CMR parametric mapping and compared it with clinical data.
The median duration of the disease was 10.2 months. The left ventricular ejection fraction was preserved in both groups. DcSSc had significantly higher native T1 (1333.4 ± 71.2 ms vs. 1295.0 ± 42.7 ms, p = 0.006) and extracellular volume fraction (32.6 ± 4.1 % vs. 30.3 ± 4.0 %, p = 0.018) in the mid-ventricular septum as compared to lcSSc, although there were no differences in T2 values. Native T1 values were positively correlated with the E/e\' ratio and left atrial volume indices evaluated by transthoracic echocardiography in overall SSc and dcSSc, but not in lcSSc. Logistic regression analysis revealed that native T1 was an independent predictor of left ventricular diastolic dysfunction in SSc patients (odds ratio, 1.194; 95 % confidence interval, 1.021-1.396; p = 0.026). Native T1 was higher in SSc patients with progressive skin lesions. Additionally, there were positive correlations between brain natriuretic peptide, New York Heart Association functional classification, and native T1.
CMR parametric mapping is a useful tool for detecting myocardial changes. Native T1 was the most sensitive parameter for identifying diffuse myocardial changes in the early stages of SSc and was associated with left ventricular diastolic function. DcSSc had more severe myocardial involvement than lcSSc; therefore, the use of CMR parametric mapping may aid in its prediction.
摘要：
背景：系统性硬化症（SSc）分为弥漫性和局限性皮肤SSc（dcSSc和lcSSc）。dcSSc亚型具有更严重的内脏器官损害。这项研究旨在评估心血管磁共振（CMR）参数标测是否可以检测早期心脏受累并评估这两种亚型之间的差异。
方法：80例SSc患者（37dcSSc和43lcSSc）在3.0T时接受了CMR（PhilipsHealthcare，最好的,荷兰）在2018年7月至2021年7月期间在我们医院。我们通过CMR参数映射分析了心肌损伤，并将其与临床数据进行了比较。
结果：中位病程为10.2个月。两组均保留左心室射血分数。DcSSc的天然T1明显较高（1333.4±71.2ms与1295.0±42.7ms,p=0.006）和细胞外体积分数（32.6±4.1％vs.30.3±4.0%,p=0.018）与lcSSc相比，尽管T2值没有差异。在整个SSc和dcSSc中，固有T1值与经胸超声心动图评估的E/e比值和左心房容积指数呈正相关，但不是在lcSSc。Logistic回归分析显示，自然T1是SSc患者左心室舒张功能不全的独立预测因子(比值比，1.194；95%置信区间，1.021-1.396；p=0.026）。SSc患者进行性皮肤病变的自然T1较高。此外,脑钠肽之间存在正相关,纽约心脏协会功能分类，和本机T1。
结论：CMR参数标测是检测心肌变化的有用工具。固有T1是识别SSc早期弥漫性心肌变化的最敏感参数，并与左心室舒张功能相关。DcSSc比lcSSc有更严重的心肌受累；因此，CMR参数映射的使用可以帮助其预测。
方法：80例SSc患者（37dcSSc和43lcSSc）在3.0T时接受了CMR（PhilipsHealthcare，最好的,荷兰）在2018年7月至2021年7月期间在我们医院。我们通过CMR参数映射分析了心肌损伤，并将其与临床数据进行了比较。
结果：中位病程为10.2个月。两组均保留左心室射血分数。DcSSc的天然T1明显较高（1333.4±71.2ms与1295.0±42.7ms,p=0.006）和细胞外体积分数（32.6±4.1％vs.30.3±4.0%,p=0.018）与lcSSc相比，尽管T2值没有差异。在整个SSc和dcSSc中，固有T1值与经胸超声心动图评估的E/e比值和左心房容积指数呈正相关，但不是在lcSSc。Logistic回归分析显示，自然T1是SSc患者左心室舒张功能不全的独立预测因子(比值比，1.194；95%置信区间，1.021-1.396；p=0.026）。SSc患者进行性皮肤病变的自然T1较高。此外,脑钠肽之间存在正相关,纽约心脏协会功能分类，和本机T1。
结论：CMR参数标测是检测心肌变化的有用工具。固有T1是识别SSc早期弥漫性心肌变化的最敏感参数，并与左心室舒张功能相关。DcSSc比lcSSc有更严重的心肌受累；因此，CMR参数映射的使用可以帮助其预测。
