Evaluation of serial cardiovascular magnetic resonance monitoring and immunosuppressive therapy in predicting outcomes in systemic sclerosis.

OBJECTIVE

Cardiac involvement is a major complication of systemic sclerosis (SSc), with myocardial fibrosis as a hallmark feature. Cardiovascular magnetic resonance (CMR) is used to detect cardiac involvement. However, the prognostic value of serial CMR monitoring and the effects of immunosuppressive therapy remain unclear. This study aimed to assess the prognostic significance of CMR parameter evolution for long-term cardiovascular outcomes and to evaluate the impact of immunosuppressive treatments on myocardial fibrosis.

METHODS

Patients from a single centre who underwent two CMR scans using the same protocol and equipment were included. CMR parameter evolution was compared using paired t-tests. The effects of treatments and changes in CMR parameters on the occurrence of major adverse cardiovascular events (MACE) and mortality were analysed using Kaplan-Meier curves and log-rank tests.

RESULTS

44 patients were included with a median (IQR) follow-up duration of 6.3 (3.1-9.2) years. The median interval between CMR scans was 1.5 (1.0-3.9) years. Seven (16%) patients had diastolic dysfunction, and 16 (36%) patients experienced MACE. Rituximab significantly decreased maximal T1 values (p=0.029), a marker of diffuse myocardial fibrosis linked to an increased risk of all-cause death (p=0.044). A significant increase in left ventricular ejection fraction (p=0.032) and a lower risk of MACE (p=0.024) were observed in patients treated with methotrexate.

CONCLUSION

Methotrexate was associated with reduced MACE risk, while rituximab decreased maximal T1 value, suggesting a reduction in diffuse myocardial fibrosis. These findings support the prognostic value of CMR monitoring and the potential benefit of immunosuppressive therapy in SSc-related cardiac involvement.