AB0653 SERUM CARDIAC BIOMARKERS BUT NOT SUBCLINICAL CARDIOVASCULAR MAGNETIC RESONANCE ABNORMALITIES IN SYSTEMIC SCLEROSIS ASSOCIATE WITH THE DEVELOPMENT OF CARDIOVASCULAR EVENTS
Authors: Raluca-Bianca Dumitru, Lesley anne Bissell, Bara Erhayiem, Graham Fent, Ananth Kidambi, Peter Swoboda, Helena Donica, Agata Burska, John Biglands, John Greenwood, Francesco Del Galdo, Sven Plein, Maya Buch
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Primary cardiac disease in systemic sclerosis (SSc-PCD) is associated with a poor prognosis when clinically evident. Subclinical SSc-PCD is described in up to 2/3 of SSc patients when sensitive methods are employed. The prognostic implication of these findings is not clear. <h3>Objectives:</h3> To describe the prevalence of cardiovascular magnetic resonance (CMR) abnormalities, their association with clinical phenotype and cardiac biomarkers, and whether cardiac biomarkers and CMR predict the development of cardiovascular (CV) events. <h3>Methods:</h3> Patients fulfilling the aCR/EULAR criteria for SSc, with no CV disease (CVD), diabetes and no more than 1 CV risk factor had 3Tesla CMR, including late gadolinium enhancement (LGE), myocardial perfusion, T1 mapping for T1 native and extracellular volume (ECV) quantification, and cardiac biomarkers measured. CV events were defined as episode of myocarditis, heart failure, rhythm disturbances and/or any echocardiographic abnormalities including systolic dysfunction, diastolic dysfunction &gt; grade 1 or regional wall motion abnormalities. 47 healthy volunteers (HV) with comparable age and gender served as controls. <h3>Results:</h3> 83 SSc patients were recruited, median (IQR) age of 54 (49, 54), 84% females and 33% dcSSc, 40% had ILD, 24% a history of digital ulceration (HxDU) and 29% were Scl70+. CMR showed higher ECV% and T1 native, markers of diffuse fibrosis in SSc compared to HV [mean (SD) 30 (4) vs 25 (3), p= 0.000; 1241 (76) vs 1206 (55), p=0.003]. Lower myocardial perfusion reserve (MPR) was also noted in SSc patients [mean (SD) 2 (0.8) vs 3 (1), p=0.000]. None of the HV had LGE-fibrosis, whilst 16 (20%) of the patients had a non-ischemic LGE pattern. Left ventricular (LV) volume and function were similar between HV and SSc patients. Presence of LGE associated with hsTnI and lower forced vital capacity (rho=0.283, p=0.032; rho=-0.217, p=0.5). Multivariate analysis revealed an association of T1 native with mRSS and CRP (B=0.5, p=0.02; B=0.218, p=0.049). ECV% associated with NTproBNP and HxDU (B=0.032, p=0.034; B=0.310, p=0.005). 73/83 had ≥1 year available clinical and echocardiography follow up data with a mean (SD) duration of 24(20) months. 12/73 had a CV event judged to be SSc-PCD. LV mass associated with CV events(p=0.043) (Table 1), whilst univariate regression analysis showed that both hsTnI (OR=1.014, p=0.014) and NTproBNP (OR=1.005, p=0.026) but none of the CMR variables associated with the development of CV events. <h3>Conclusion:</h3> Asymptomatic SSc patients with no overt CVD demonstrate both focal and diffuse fibrosis, which are associated with cardiac biomarkers and markers of SSc disease activity. Whilst hsTnI and NTproBNP associated with the development of CV events, none of the measures of fibrosis did although a higher LV mass was noted in this group. The prognostic implications of subclinical CMR findings remain unclear and would benefit from longer follow-up. <h3>Disclosure of interests:</h3> Raluca-Bianca Dumitru: None declared, Lesley anne Bissell: None declared, Bara Erhayiem: None declared, Graham Fent : None declared, ananth Kidambi : None declared, Peter Swoboda: None declared, Helena Donica: None declared, agata Burska : None declared, John Biglands : None declared, John Greenwood: None declared, Francesco Del Galdo: None declared, Sven Plein : None declared, Maya Buch Grant/research support from: Pfizer LTD, UCB, Consultant for: abbVie, Eli Lilly, EMD Serono, Pfizer Ltd., Sanofi