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Background: Primary heart involvement(pHI) is frequent in systemic sclerosis(SSc), and is associated with a poor prognosis. Myocardial inflammation has been recently identified as an important and potentially reversible pathogenic event in SSc-pHI. However, no consensus has been reached on which SSc patients should perform cardiac magnetic resonance(CMR), and the clinical features associated with the presence of myocardial inflammation at CMR still remain poorly defined. Objectives: to investigate clinical, serological, and instrumental features of SSc patients associated with the presence of active myocardial inflammation at CMR. Methods: we retrospectively analyzed data from SSc patients who underwent CMR for a clinically suspected pHI, defined by the presence of cardiac symptoms (dyspnea, chest pain, palpitations, lower limbs edema, syncope) and/or signs (increase cardiac biomarkers, and/or presence of at least one abnormality at echocardiography and/or 24h-ECG-Holter) in the absence of progressive interstitial lung disease, WHO III-IV or worsened pulmonary arterial hypertension, renal failure, diagnosed coronary artery disease or other cardiac conditions. All patients underwent a comprehensive evaluation of disease characteristics and organ involvement, chiefly cardiac involvement, including: signs and symptoms of heart disease, serum levels of high-sensitive troponin-T(hsTnT) and NT-proBNP, inflammatory markers, ECG and 24h-ECG Holter, echocardiography and CMR. At CMR we analyzed: biventricular function, left and right chambers size, myocardial edema on STIR images, T2 myocardial/skeletal muscle ratio, early and late gadolinium enhancement (EGE and LGE), native T1 mapping, T2 mapping, and extracellular volume(EVC). Univariate and multivariate analysis were performed. A p value Results: 100 SSc patients (females 85%; mean age 53.0±13.2 years; anti-topoisomerase-I positivity 41%; diffuse cutaneous subset 34%; early disease Conclusion: the presence of VEBs at 24h-ECG Holter may serve as a predictive factor for an active myocardial inflammation detected at CMR in SSc patients with suspected pHI. The early detection of myocardial inflammation is crucial to promptly identify SSc patients eligible for immunosuppressive therapy. Our data suggest that 24h-ECG Holter should be routinely performed to triage SSc patients to decide when CMR with mapping techniques should be mandatory in those with VEBs. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.
Luca et al. (Sat,) studied this question.