Journal Article

POS1413 EXPLORING THE POTENTIAL ROLE OF CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY IN THE EARLY DETECTION OF CARDIAC INVOLVEMENT IN PATIENTS WITH SYSTEMIC SCLEROSIS

Chiocchi, M., Idone, G., Kroegler, B., Ricci, M. G., Chimenti, M. S., Panetta, M., Marchei, M., Greco, E., Modica, S., Fatica, M., Cristiano, I., Triggianese, P., Luciano, A.

2024

Overview

Background:In systemic sclerosis (SSc), primary heart involvement (pSHI) is a major cause of related death. In most cases, pSHI is subclinical especially in early stages of disease. pSHI is related to both fibrosis and coronary lesions potentially leading to chronic heart failure (CHF). Coronary computed tomography angiography (CCTA) is a non-invasive imaging modality with high sensitivity for the detection of coronary lesions. The early diagnosis of cardiac involvement in SSc is a key challenge for the improvement of both damage and burden of the disease.Objectives:The study aimed at exploring for the first time the potential role of CCTA in the early detection of subclinical cardiac involvement in SSc patients.Methods:A prospective cohort study included patients fulfilling the following inclusion criteria: 1. a defined diagnosis of SSc according to 2013 ACR/EULAR classification criteria; 2. age>18 y.o.; 3. no history of cardiovascular disease (including severe hypertension and CHF); 4. consent to study. All included subjects referred to SSc Reference Center of the Rheumatology Unit (“Tor Vergata”, Rome, Italy) between March 2023 and December 2023. Patients underwent clinical and laboratory evaluation for traditional cardiovascular risk factors and SSc assessment, nailfold video capillaroscopy (NVC), a color doppler trans-thoracic echocardiogram, and CCTA. Detailed analysis from NVC was performed by an expert Rheumatologist. The CT protocol foresaw a low dose basal acquisition on thoracic volume to evaluate pulmonary interstitium, followed by a cardio-synchronized CT angiography acquisition to assess coronary arteries.Results:The study cohort included 13 patients (92.3% women) with a mean age of 68.6 ± 7.9 y.o. Demographic and clinical data were reported in Table 1. The limited cutaneous SSc (lcSSc) represented 61.5% of the cohort while the remaining was the diffuse cutaneous (dcSSc). In accordance with CCTA findings, patients were divided in non-significant coronary abnormalities (group 1) and luminal severe stenosis (group 2). Group 2 included 30.7% of the cohort (n=4) and required subsequent coronary interventions in all cases. The dcSSc phenotype was prevalent in group 2 than in group 1 (p<0.05) as well as the concomitant interstitial lung disease (ILD, p=0.02). Patients from group 2 showed active-late NVC pattern in a higher percentage than those from group 1 (p=0.03).Conclusion:Preliminary findings from our pilot proof-of-concept study for the first time provide evidence of severe coronary lesions in asymptomatic SSc patients. These vascular changes revealed by CCTA appear to be associated with dcSSc phenotype and concomitant ILD and could precede CHF. CCTA findings might improve SSc management by an early detection of subclinical damage and a tailored risk stratification for the disease outcome.Table 1.Demographic, clinical, and laboratory data from patients with systemic sclerosis (SSc) with non-significant coronary abnormalities (group 1) and luminal severe stenosis (group 2) detected by using coronary computed tomography angiography.Group 1N=9Group 2N=4Diffuse cutaneous, N (%)2 (22.2)3 (75)Age, mean ± SD70.6±5.668.6±7.9Smoking habits, N (%)4 (44.4)2 (50)Body mass index, mean ± SD24±524.1±4.6Cholesterol HDL, mean ± SD61.9±15.760.2±15.2Cholesterol total, mean ± SD200.2±46205±47.9Brain natriuretic peptide, mean ± SD106.1±134.597.7±136.9Disease duration, mean ± SD23.9±15.326.9±16.1Raynaud phenomenon, N (%)9 (100)4 (100)Interstitial lung disease, N (%)2 (22.2)3 (75)Pulmonary arterial hypertension, N (%)3 (33.3)1 (25)Figure 1.A representative scan of coronary computed tomography angiography from a female patient with systemic sclerosis shows a significant stenosis resulting in positive remodelling of the proximal segment of the left anterior descending artery.REFERENCES: NIL. Acknowledgements:NIL.Disclosure of Interests:None declared.

• Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism,Elsevier B.V,Elsevier Limited
• Subject: Age / Angiography / Body mass index / Brain natriuretic peptide / Cardiovascular diseases / Cholesterol / Computed tomography / Congestive heart failure / Coronary artery disease / Demography / Diagnosis / Diagnostic test / Doppler effect / Echocardiography / Fibrosis / High density lipoprotein / Hypertension / Imaging / Lesions / Lung diseases / Medical imaging / Neuroimaging / Outcome measures / Phenotypes / Rheumatology / Risk factors / Scientific Abstracts / Scleroderma / Stenosis / Systemic sclerosis / Thorax / Tomography