Cardiac inflammation in populations with systemic sclerosis evaluated by T1 mapping via magnetic resonance: A systematic review and Meta Analysis

Abstract

BACKGROUND: Patients with systemic sclerosis (SSc) frequently demonstrate subclinical myocardial inflammation which can predispose them to developing clinical heart failure. Cardiac magnetic resonance (CMR) is an imaging modality that can accurately characterize myocardial tissue. We hypothesize that patients with SSc, compared to controls, demonstrate evidence of myocardial inflammation on advanced tissue characterization indices. METHODS: A systematic search of medical databases was performed using PRISMA principles to identify all relevant studies assessing CMR parameters in SSc patients versus controls (2000-2022; English). A range of CMR parameters were extracted and then metaanalyzed using a random-effects model for overall effect size, and assessed through standardized mean difference (SMD). RESULTS: 10 studies were included for analysis. Native T1 (SMD: 1.20, 95% CI: 0.61-1.80, p=0.01) and extracellular volume (SMD: 1.26, 95% CI: 0.79-1.73, p=0.02) had the greatest overall effect sizes, and importantly, were the only parameters with statistical significance. All other parameters comparing chamber size and function were non-significant between SSc and controls (p>0.05). See Table. CONCLUSION: Compared to controls, patients with SSc demonstrate abnormal myocardial tissue characteristics, despite normal structural and functional chamber assessments. Early identification of subclinical inflammation may allow for protective immunosuppressive therapy.