Strain Analysis using Feature-Tracking CMR: A predictor of Pulmonary Arterial Hypertension in Systemic Sclerosis? (RF_TH_193)

The aim of this study was to assess the role of cardiac strain analysis using feature-tracking cardiac magnetic resonance (CMR) in patients with Systemic sclerosis (SSc).



Methods:

96 consecutive patients diagnosed with SSc (aged 58±18 years, 61 females, duration 5.9±4 years) and referred for CMR were enrolled in this retrospective study. The study classified subjects into two groups: Group 1 (n=26) with evidence of Pulmonary Arterial Hypertension (PAH) based on clinical evaluations, and Group 2 (n=70) with documented history of SSc, categorized as either limited or diffuse cutaneous subtype. The CMR comprehensive protocol included conventional cine imaging, T1 and T2 parametric mapping, and late gadolinium enhancement (LGE) imaging. Bi-ventricular global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS) were measured (cvi42, Circle Cardiovascular Imaging).



Results:

Despite preserved ejection fraction (LVEF-RVEF), GLS of the left ventricle (LV) was decreased in both groups but more impaired in Group1 compared to Group2 (GLS= -11.9±3.5 vs -15.3±4.1, p=0.003). GLS of the right ventricle (RV) was significantly lower in Group1 compared to Group2 (GLS= -17.4±4.3 vs -24.7±7.0, p< 0.001). In both groups, patients with elevated T1 mapping values exhibited reduced LV GLS compared to those with normal T1 (P=0.017).  Patients with septal or subendocardial LGE (pattern1) demonstrated a higher reduction of GLS in both the LV and RV when compared to individuals with minimal focal at RV insertion point (pattern2). All strain parameters showed no correlation with the disease duration (r=0.13, P< 0.001).

 



Conclusion:

In SSc, strain parameters decrease even when the LVEF and RVEF remain within the normal range. GLS and LGE may serve as prognostic biomarkers for PAH in patients with SSc.