TY - JOUR
TI - Cardiac magnetic resonance predicts ventricular arrhythmias in
scleroderma: the Scleroderma Arrhythmia Clinical Utility Study (SAnCtUS)
AU - Mavrogeni, Sophie
AU - Gargani, Luna
AU - Pepe, Alessia
AU - Monti, Lorenzo
AU - and Markousis-Mavrogenis, George
AU - De Santis, Maria
AU - De Marchi,
AU - Daniele
AU - Koutsogeorgopoulou, Loukia
AU - Karabela, Georgia and
AU - Stavropoulos, Efthymios
AU - Katsifis, Gikas
AU - Bratis, Konstantinos and
AU - Bellando-Randone, Silvia
AU - Guiducci, Serena
AU - Bruni, Cosimo and
AU - Moggi-Pignone, Alberto
AU - Dimitroulas, Theodoros
AU - Kolovou, Genovefa
AU - and Bournia, Vasiliki-Kalliopi
AU - Sfikakis, Petros P. and
AU - Matucci-Cerinic, Marco
JO - Rheumatology (Bulgaria)
PY - 2020
VL - 59
TODO - 8
SP - 1938-1948
PB - Oxford University Press
SN - null
TODO - 10.1093/rheumatology/kez494
TODO - scleroderma; systemic sclerosis; cardiovascular magnetic resonance;
sudden cardiac death; rhythm disturbance
TODO - 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.
ER -