PT  - JOURNAL ARTICLE
AU  - HITOMI KOBAYASHI
AU  - ISAMU YOKOE
AU  - MASAHARU HIRANO
AU  - TETSUYA NAKAMURA
AU  - YASUO NAKAJIMA
AU  - KEVIN R. FONTAINE
AU  - JON T. GILES
AU  - YASUYUKI KOBAYASHI
TI  - Cardiac Magnetic Resonance Imaging with Pharmacological Stress Perfusion and Delayed Enhancement in Asymptomatic Patients with Systemic Sclerosis
AID  - 10.3899/jrheum.080377
DP  - 2009 Jan 01
TA  - The Journal of Rheumatology
PG  - 106--112
VI  - 36
IP  - 1
4099  - http://www.jrheum.org/content/36/1/106.short
4100  - http://www.jrheum.org/content/36/1/106.full
SO  - J Rheumatol2009 Jan 01; 36
AB  - Objective. To assess cardiac involvement in asymptomatic patients with systemic sclerosis (SSc) by cardiac magnetic resonance imaging (MRI). Methods. Ten asymptomatic patients with SSc (all female; mean age 59.5 ± 9.4 yrs) underwent contrast enhanced cardiac MRI on a 1.5 T MRI device. Adenosine triphosphate was used for stress and rest perfusion to assess perfusion defects due to microvascular impairment or ischemia, and delayed enhanced (DE) imaging was obtained for the assessment of myocardial necrosis and fibrosis. We evaluated the pathophysiological associations of stress perfusion combined with DE imaging with SSc disease severity measures. Results. Stress perfusion defects were seen in 5 out of 9 patients (56%): 4 had nonsegmental subendocardial perfusion defects and one had a segmental subendocardial perfusion defect. Three patients were found to have DE. DE was not observed in any patient without perfusion defect; and among the 5 patients with perfusion defects, 3 (60%) had DE. Two of the 3 had DE in segments not matching the region of nonsegmental perfusion defects. The remaining one had a segmental subendocardial DE matching the region of a segmental perfusion defect. Perfusion defects were seen in 75% of patients with a history of digital ulceration compared to only 20% of those without history of ulceration. Conclusion. Subclinical myocardial involvement, as detected by cardiac MRI, was frequent in asymptomatic patients with SSc. Cardiac MRI may aid in understanding the pathophysiological mechanism of SSc.