Primary heart involvement assessed by cardiac magnetic resonance is associated with capillaroscopy abnormalities in systemic sclerosis

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BACKGROUND: Heart involvement is a common complication in patients with systemic sclerosis (SSc). Primary heart involvement associated with SSc (SSc-HI) can be assessed via cardiac magnetic resonance (CMR), a sensitive method that evaluates morphology, function, and tissue characteristics indicative of microvascular dysfunction, inflammatory, and fibrotic changes. This study aimed to investigate the relationship between SSc-HI evaluated by CMR after cold stress protocol and the peripheral vasculopathy assessed by nailfold capillaroscopy in SSc patients. METHODS: A cross-sectional exploratory study including 40 SSc patients was performed. CMR measured morphology, function, and strain. SSc-HI CMR vasculopathy-related lesions were evaluated by perfusion defects and myocardial perfusion reserve (MPR); fibrosis-related lesions were evaluated by late gadolinium enhancement (LGE), reduced left ventricular global longitudinal strain (LV-GLS), and biventricular failure. The following parameters were evaluated via videocapillaroscopy: mean capillary/mm, giant capillaries, avascular score, and the presence of a late scleroderma (SD) or non-late SD pattern. RESULTS: SSc-HI on CMR was observed in 22 (55%) patients. Vasculopathy and fibrosis-related lesions were observed in 15 (37.5%) and 8 (20%) patients, respectively. The late SD pattern group had a significantly higher frequency of moderate/severe pericardial effusion (p = 0.04) and a higher frequency of fibrosis-related lesions (p = 0.01), with more patients presenting with an LV-GLS < 14% (p = 0.01) and LGE (p < 0.01) than in the patients with the non-late SD pattern. A lower number of capillary loops/mm and a higher avascular score were associated with fibrosis-related lesions (p < 0.01 and p = 0.01, respectively), myocardial involvement (p < 0.01, both) and any SSc-HI (p = 0.01 and p < 0.01, respectively). CONCLUSIONS: SSc-HI CMR changes indicative of vasculopathy and fibrosis were frequently observed and associated with more severe capillaroscopic abnormalities, suggesting that the peripheral microcirculation may mirror cardiac injuries. Thus, the association between CMR and capillaroscopy indicated that capillaroscopy changes might be associated with SSc-HI.