POS0845 PREDICTORS OF PRIMARY HEART INVOLVEMENT DEFINED BY CARDIAC MAGNETIC RESONANCE IN SYSTEMIC SCLEROSIS
Authors: G. De Luca, V. Batani, C. Campochiaro, A. Palmisano, A. Esposito, L. Dagna, M. Matucci-Cerinic
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> primary heart involvement (pHI) is frequent in systemic sclerosis (SSc) and it is associated with a bad prognosis; early recognition is therefore essential. Cardiac magnetic resonance (CMR) represents the non-invasive tool of choice for diagnosing myocardial involvement in SSc-pHI. <h3>Objectives:</h3> to analyze the predictors of SSc pHI at CMR in a large monocentric cohort of SSc patients. <h3>Methods:</h3> Among SSc patients followed up at our centre, those who underwent CMR for suspected pHI (i.e. clinical signs and/or symptoms or instrumental signs suggestive for heart involvement) were identified. Clinical, laboratory and instrumental features were compared between pHI-SSc and non-pHI-SSc patients, and between CMR positive and CMR negative patients. Univariable and multivariable logistic regression were used to identify predictors of pHI-SSc at CMR. <h3>Results:</h3> 259 SSc patients (females 89.6%; median age 49 [39-61] years were incvluded; median disease duration 99 [60-153] months; diffuse disease 17%; anti-topoisomerase I positivity 28.2%; very early diagnosis of SSc [VEDOSS] 28.6%). CMR, performed in 56 SSc patients (21%), detected pHI in 37 patients (14%). Comparative features of pHI-SSc and non-pHI-SSc patients are summarized in Table 1. At univariate analysis, age at SSc onset, diffuse cutaneous subset, increase of inflammatory markers and cardiac enzymes, presence interstitial lung disease (ILD) and myositis were significantly associated with SSc-pHI, whereas an inverse correlation emerged with anti-centromere antibodies positivity, VEDOSS diagnosis and female gender. At multivariate analysis, increased serum levels of troponin T (TnT [OR 14.108, CI 2.772-71.808,p=0.014]) and C-reactive protein (CRP [OR 11.237, CI 2.265-55.763, p=0.0031]), and presence of ILD [OR 6.275, CI 1.240-31.763, p= 0.0264]), emerged as risk factors for SSc-pHI. In 56 patients who underwent CMR, only the presence of an arrhythmic event documented by 24h-ECG Holter emerged at univariate analysis as a predictor for SSc-pHI (OR 3.75, IC 1.041-13.5, p=0.04). In the 37 patients with CMR positive for SSc-pHI, signs of active myocardial inflammation (i.e. myocardial edema, increased T2 mapping and/or early gadolinium enhancement [EGE]) were disclosed in 20 cases (54%), while 17 patients (46%) had signs suggestive for chronic involvement/fibrotic changes (i.e. increased T1 mapping and/or extracellular volume [ECV], areas of late gadolinium enhancement [LGE] with non-ischemic pattern). CMR findings are summarized in <b>Table 2.</b> In the subgroup of 37 patients with positive CMR, an arrhythmic presentation, disclosed in 17/37 (46%) patients with SSc-pHI, emerged at univariate analysis as a predictor for the presence of chronic myocardial damage at CMR (OR 3.750, CI 1.108-12.694, p=0.003). No other associations were found between clinical features and CMR subsets of myocardial involvement. <h3>Conclusion:</h3> A comprehensive analysis of disease features may predict the SSc-pHI involvement. Increased serum levels of TnT and CRP, and the presence of ILD and arrhythmias at 24h-ECG Holter may be considered as -pHI red flags in SSc patients. Moreover, the arrhythmic burden significantly correlates with a chronic myocardial damage disclosed by CMR. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>