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Introduction Cardiac involvement in systemic sclerosis (SSc) is more common than in other autoimmune rheumatic diseases (ARDs) and includes myocardial inflammation, fibrosis, and potential progression to cardiomyopathy. Cardiovascular magnetic resonance (CMR) imaging is crucial for diagnosing cardiac involvement in SSc, but current evidence is from small-scale single-center studies. This study aims to evaluate CMR characteristics and prognostic implications of cardiac involvement in a multicenter SSc cohort compared to other ARDs.Material and Methods This pooled multicenter study included ARD patients who underwent CMR with gadolinium-based contrast at Yale University (retrospective cohort), University of Leeds (prospective cohort), and University of Athens (retrospective cohort). Board-certified cardiologists/radiologists calculated left ventricular (LV) and right ventricular (RV) volumes and ejection fraction (EF). Myocardial fibrosis/scar was identified as hyperenhancement on late gadolinium enhancement (LGE) images. Continuous variables were compared between SSc and other ARDs using the Mann-Whitney U test, and categorical variables using the chi-square test. Kaplan-Meier analysis evaluated overall survival, and statistical analysis was performed with R (version 1.81) and R Studio. A two-sided P-value <0.05 was considered significant.Results The final cohort included 822 ARD patients (median age 61 years [interquartile range: 49-70], 70% female), with 130 SSc patients (73 with limited cutaneous SSc, 77 with interstitial lung disease, and 49 with pulmonary artery hypertension) and 692 other ARDs, predominantly rheumatoid arthritis (n=335) and systemic lupus erythematosus (n=144). SSc patients were more often female, had lower body mass index, smaller indexed end-diastolic and end-systolic LV volumes, higher LVEF, and lower indexed myocardial mass compared to other ARDs ( table 1). Indexed end-diastolic RV volume was significantly higher in SSc. LGE was found in 48 (63%) SSc and 263 (62%) ARD patients with similar LGE patterns (table 1). During a median follow-up of 3.2 years (interquartile range: 1.2-6.6 years), 107 patients (13%) died. SSc patients with LGE had worse survival compared to other ARDs with LGE (HR: 2.39, 95% CI: 1.30-4.40, p=0.005) or SSc without LGE (HR: 2.40, 95% CI: 1.16-4.98, p=0.02) (figure 1). There was no difference in survival when comparing SSc without LGE and ARD without LGE (HR: 1.67, 95% CI: 0.92-3.05, p=0.09).Conclusions In this large multicenter cohort study, SSc patients showed distinct cardiac features with smaller LV size, larger RV size, and similar LGE incidence compared to other ARDs. Importantly, SSc patients with LGE faced significantly higher mortality, highlighting the need for close clinical follow-up and targeted management in this high-risk group.Abstract OC.06 Figure 1Overall survival based on systemic sclerosis (SSc) status and late gadolinium enhancement (LGE)Abstract OC.06 Table 1Baseline characteristics