SAT0253\u2005PROGNOSTIC VALUE OF CARDIAC MAGNETIC RESONANCE IN SYSTEMIC SCLEROSIS

Abstract

Background: Cardiac involvement is frequent in patients with systemic sclerosis (SSc). It is often subclinical, but significantly affects the prognosis of the disease. Cardiovascular magnetic resonance (CMR) is the non-invasive gold standard to quantify biventricular functional parameters and to perform a myocardial tissue characterization. Objectives: To evaluate the prognostic value of CMR for cardiac events in SSc. Methods: Two hundred and seventy-three SSc patients with a thorough clinical assessment underwent a CMR exam using a 1.5 T GE scanner. We quantified biventricular function parameter by SSFP cine images, oedema by STIR T2 images, and macroscopic fibrosis by late gadolinium enhancement (LGE) technique. Patients were followed-up and cardiac events were recorded as new onset of pulmonary arterial hypertension (PAH), new onset of heart failure (HF), or at least sustained ventricular tachycardia. Results: Mean follow-up was 23.9 ± 17.0 months. During the follow-up a total of 14 events occurred (3 new onset PAH, 5 new onset HF, 6 ventricular tachycardia). CMR predictors of cardiac events by univariate analysis were left and right ventricular ejection fractions, indexed left and right atrial areas, and LGE (see Table). Myocardial fibrosis by LGE was the only independent predictor at multivariate analysis (hazard ratio 3.175; 95% C.I. 1.021-9.870, see Figure). Univariate analysis Multivariate analysis HR (95% CI) p HR (95% CI) p Left Ventricular Ejection Fraction 0.904 (0.843 – 0.969) 0.004 0.935 (0.868 – 1.007) 0.075 Indexed Left Atrial Area 1.244 (1.002 – 1.546) 0.048 Right Ventricular Ejection Fraction 0.926 (0.884 – 0.969) 0.001 0.958 (0.904 – 1.014) 0.139 Indexed Right Atrial Area 1.384 (1.059 – 1.809) 0.017 Right Ventricular End-Diastolic Mass 1.039 (0.991 – 1.091) 0.115 Right Ventricular End-Systolic Mass 1.036 (0.988 – 1.086) 0.148 T2 ratio 0.247 (0.019 – 3.251) 0.288 Late Gadolinium Enhancement 3.871 (1.289 – 11.623) 0.016 3.175 (1.021-9.870) 0.046 Conclusion: Cardiac magnetic resonance anatomical and functional parameters of both the left and right heart have significant prognostic value in patients with SSc. Disclosure of Interests: Cosimo Bruni: None declared, Luna Gargani: None declared, Alessia Pepe: None declared, Antonella Meloni: None declared, Daniele De Marchi: None declared, Giancarlo Todiere: None declared, Fabio Fulgenzi: None declared, Yacob Ghebru: None declared, Serena Guiducci: None declared, Raffaele De Caterina: None declared, Marco Matucci-Cerinic Grant/research support from: Actelion, MSD, Pfizer, BMS, Chemomab, Sanipedia, Speakers bureau: Actelion, BMS; MSD, Janssen