Cardiac magnetic resonance predicts ventricular arrhythmias in scleroderma: the Scleroderma Arrhythmia Clinical Utility Study (SAnCtUS).

Abstract

OBJECTIVES:

Cardiac rhythm disturbances constitute the most frequent cardiovascular cause of death in SSc. However, electrocardiographic findings are not a part of risk stratification in SSc. We aimed to translate 24 h Holter findings into a tangible risk prediction score using cardiovascular magnetic resonance.

METHODS:

The Scleroderma Arrhythmia Clinical Utility Study (SAnCtUS) was a prospective multicentre study including 150 consecutive SSc patients from eight European centres, assessed with 24 h Holter and cardiovascular magnetic resonance, including ventricular function, oedema (T2 ratio) and late gadolinium enhancement (%LGE). Laboratory/clinical parameters were included in multivariable corrections. A combined endpoint of sustained ventricular tachycardia requiring hospitalization and sudden cardiac death at a median (interquartile range) follow-up of 1 (1.0-1.4) year was generated.

RESULTS:

Only T2 ratio and %LGE were significant predictors of ventricular rhythm disturbances, but not of supraventricular rhythm disturbances, after multivariable correction and adjustment for multiple comparisons. Using decision-tree analysis, we created the SAnCtUS score, a four-category scoring system based on T2 ratio and %LGE, for identifying SSc patients at high risk of experiencing ventricular rhythm disturbance at baseline. Increasing SAnCtUS scores were associated with a greater disease and arrhythmic burden. All cases of non-sustained ventricular tachycardia (n = 7) occurred in patients with the highest SAnCtUS score (=4). Having a score of 4 conveyed a higher risk of reaching the combined endpoint in multivariable Cox regression compared with scores 1/2/3 [hazard ratio (95% CI): 3.86 (1.14, 13.04), P = 0.029] independently of left ventricular ejection fraction and baseline ventricular tachycardia occurrence.

CONCLUSION:

T2 ratio and %LGE had the greatest utility as independent predictors of rhythm disturbances in SSc patients.

• Authors: Sophie Mavrogeni, Luna Gargani, Alessia Pepe, Lorenzo Monti, George Markousis-Mavrogenis, Maria De Santis, Daniele De Marchi, Loukia Koutsogeorgopoulou, Georgia Karabela, Efthymios Stavropoulos, Gikas Katsifis, Konstantinos Bratis, Silvia Bellando-Randone, Serena Guiducci, Cosimo Bruni, Alberto Moggi-Pignone, Theodoros Dimitroulas, Genovefa Kolovou, Vasiliki-Kalliopi Bournia, Petros P Sfikakis, Marco Matucci-Cerinic
• Journal: Rheumatology (Oxford, England) (Rheumatology (Oxford)) Vol. 59 Issue 8 Pg. 1938-1948 (08 01 2020) ISSN: 1462-0332 [Electronic] England
• PMID: 31764972 (Publication Type: Journal Article)
• Copyright: © The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology.

Topics

• Adult
• Aged
• Arrhythmias, Cardiac (diagnostic imaging, etiology)
• Female
• Heart Ventricles (diagnostic imaging)
• Humans
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Prospective Studies
• Scleroderma, Systemic (complications, diagnostic imaging)
• Ventricular Function, Left