Heart involvement in systemic sclerosis: Evolving concept and diagnostic methodologies

• Published in: Archives of cardiovascular diseases Vol. 103; no. 1; pp. 46 - 52
• Main Authors: Meune, Christophe, Vignaux, Olivier, Kahan, André, Allanore, Yannick
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Masson SAS 01-01-2010; Elsevier
• Subjects: Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Biomarkers - blood; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular; Cardiovascular system; Diagnostic Imaging - methods; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Doppler tissulaire myocardique; Echocardiography, Doppler; Fibrosis; Heart - physiopathology; Heart Diseases - diagnosis; Heart Diseases - etiology; Heart Diseases - pathology; Heart Diseases - physiopathology; Heart Function Tests - methods; Humans; Internal Medicine; Investigative techniques, diagnostic techniques (general aspects); Ischaemia; Ischémie; Magnetic Resonance Imaging; Medical sciences; Myocarde; Myocardial Perfusion Imaging; Myocardium; Myocardium - pathology; Natriuretic peptides; Peptides natriurétiques; Practice Guidelines as Topic; Predictive Value of Tests; Prevalence; Prognosis; Reperfusion; Risk Assessment; Risk Factors; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Scleroderma, Systemic - complications; Scleroderma, Systemic - pathology; Scleroderma, Systemic - physiopathology; Severity of Illness Index; Tissue doppler echocardiography; Ultrasonic investigative techniques; Vasospasme; Ischaemia; Peptides natriurétiques; Reperfusion; Vasospasme; Myocarde; Doppler tissulaire myocardique; Myocardium; Ischémie; Tissue doppler echocardiography; Natriuretic peptides; Sonography; Heart; Concept; Doppler ultrasound study; Immunopathology; Connective tissue disease; Skin disease; Methodology; Tissue doppler; Autoimmune disease; Cardiovascular disease; Ischemia; Systemic disease; Vasospasm; Diagnosis; Cardiology; Scleroderma
• ISSN: 1875-2136; 1875-2128
• DOI: 10.1016/j.acvd.2009.06.009

Summary Heart involvement, including primary myocardial involvement, is very common in systemic sclerosis. There is strong evidence that primary myocardial involvement is related to repeat focal ischaemic injury causing subsequent irreversible myocardial fibrosis. Clinically evident cardiac involvement is recognized to be a poor prognostic factor; thus preclinical identification is highly encouraged. The severity of heart involvement has been confirmed recently. Echocardiography, including pulsed tissue Doppler echocardiography, is the cornerstone of routine heart assessment. Myocardial perfusion may be assessed by single photon emission computed tomography. If available, cardiac magnetic resonance imaging should be considered as it allows simultaneous measurement of ventricular volumes and function and myocardial perfusion, and assessment of possible inflammation and/or fibrosis. Biological variables, such as B-type natriuretic peptides, are highly relevant, valuable markers of global heart involvement in systemic sclerosis and should be considered for screening of patients and/or research purposes.