Rapid Fire Abstracts
Chin Yit Soo, BSc, MB
Clinical research fellow
University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, LS2 9JT, United Kingdom, United Kingdom
Chin Yit Soo, BSc, MB
Clinical research fellow
University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, LS2 9JT, United Kingdom, United Kingdom
Lucy Thornton, MB
Rheumatology Registrar
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, United Kingdom
Stefano Di Donato, MD
Rheumatology registrar
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, United Kingdom
Vishal Kakkar, MB
Rheumatology registrar
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, United Kingdom
Riccardo Bixio, MD
Rheumatology registrar
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, United Kingdom
Raluca Tomoaia, MD, PhD
Clinical Research Fellow
Leeds Institute of Cardiovascular and Metabolic Medicine, United Kingdom
Thomas Anderton, MBChB
Clinical research fellow
University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, LS2 9JT, United Kingdom, United Kingdom
May T. Lwin, MB
Clinical Research Fellow
University of Leeds, United Kingdom
Mehak Asad, MB
Clinical research fellow
University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, LS2 9JT, United Kingdom, United Kingdom
Christel Kamani, MD, PhD
Consultant Cardiologist
University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, LS2 9JT, United Kingdom, United Kingdom
Amrit Chowdhary, MD
Cardiology Research Fellow
University of Leeds, United Kingdom
Sharmaine Thirunavukarasu, MbCHB
Cardiology Research Fellow
University of Leeds, United Kingdom
Henry Procter, MBChB
Cardiology research fellow
University of Leeds, United Kingdom
Sindhoora Kotha, BSc, MB
Cardiology Clinical Research Fellow
University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, LS2 9JT, United Kingdom, United Kingdom
Marilena Giannoudi, MRes(Hons), MSc, MRCP, FHEA
Cardiology Research Fellow
University of Leeds, United Kingdom
Eylem Levelt, PhD
Professor of Cardiology
The Baker Heart and Diabetes Institute , Australia
Francesco Delgaldo, PhD
Professor of Rheumatology
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, United Kingdom
Sven Plein, MD PhD
Professor of Cardiovascular Imaging
University of Leeds, United Kingdom
Lesley-Anne Bissell, PhD
Consultant Rheumatologist
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, United Kingdom
Nicholas Jex, PhD
Cardiology Research Fellow
University of Leeds, United Kingdom
Primary cardiac involvement in systemic sclerosis (SSc) is heterogenous and poorly defined. In patients with SSc, bi-ventricular failure and cardiac arrythmia remain the leading cause of cardiac morbidity and mortality. The mechanism behind these associations is not well understood but may include the impact of coronary microvascular dysfunction and myocardial inflammation. Myocardial metabolic alterations in SSc are yet to be established.
Using 31 Phosphorous magnetic resonance spectroscopy (31 P MRS) and cardiovascular magnetic resonance (CMR), we sought to establish if myocardial energetics, measured as phosphocreatine (PCr) /ATP ratio and quantitative myocardial perfusion were reduced in individuals with SSc compared to healthy volunteers (HV).
Methods:
A total of 58 age and sex matched participants were recruited (38 SSc, 20 HV). All subjects underwent 31 P MRS and comprehensive CMR protocol including volumetric analysis, quantitative myocardial perfusion and T1 mapping (Fig 1).
All scans were conducted on a Siemens 3 Tesla PRISMA MR system (Erlangen, Germany). Perfusion imaging used a free breathing, fast low angle shot (FLASH) magnetic resonance protocol with motion-corrected (MOCO) automated in-line perfusion mapping using the Gadgetron streaming software image reconstruction framework. Myocardial perfusion image reconstruction and processing was implemented using the Gadgetron software framework as previously described.
All 31P-MRS data were acquired with a non-gated 3D acquisition weighted CSI technique with 10 averages at the centre of K-space and ultrashort TE to minimise T2 effects and first order phase artefacts. 31P-MRS post processing analysis was performed using a custom Matlab software (Mathworks, Natick, Mass).
Results:
Cardiac geometry and function
Table-1 shows clinical and CMR / 31 P MRS data. Bi-ventricular volumes, systolic function and left atrial function were similar in both groups. NT-Pro BNP was significantly increased in SSc (p= 0.0007).
Myocardial fibrosis
Native T1 (HV: 1235±88, SSc: 1368±38, p= < 0.0001) and ECV (HV: 24±3, SSc: 28±3, p= < 0.0001) were significantly elevated in SSc.
Myocardial perfusion
Myocardial perfusion reserve (MPR) was significantly reduced in SSc (HV: 3.4±0.8, SSc: 2.6±0.6, p= 0.003, fig 2). Stress myocardial blood flow (MBF) was numerically lower in SSc but did not reach significance (p=0.07).
Myocardial energetics
Myocardial PCr/ATP was significantly reduced in SSc versus healthy controls (HV: 2.49±0.3, SSc: 1.93±0.5, p= 0.0005, fig2).
Conclusion:
We show for the first time that patients with systemic sclerosis demonstrate significant reductions in myocardial energetics compared to age, sex and BMI matched healthy controls. Individuals with SSc also demonstrate reduced myocardial perfusion and increased myocardial fibrosis. These findings may be important components of the adverse cardiovascular outcomes seen in patients with systemic sclerosis.
