{
  "abstract": "Introduction Systemic sclerosis (SSc) is a rare systemic autoimmune disease that may result in primary scleroderma cardiomyopathy (SSc-CMP), a leading cause of adverse outcomes and impaired quality of life. However, its clinical definition is not yet universally established. Left atrial strain (LAS), an echocardiographic parameter reflecting global left atrial function, has been proposed as an early marker of myocardial involvement in other inflammatory conditions, but its role in SSc-CMP remains unclear. Considering the presumed inflammatory pathogenesis of SSc-CMP, we aimed to assess whether LAS can enable the early detection of this condition.Material and Methods In this single-center retrospective study, 179 patients fulfilling the 2013 ACR/EULAR classification criteria for SSc, presenting with dyspnea and suspected cardiovascular involvement, underwent comprehensive clinical assessment, laboratory testing, transthoracic echocardiography with speckle-tracking analysis of LAS, cardiopulmonary exercise testing, and, when indicated, cardiac magnetic resonance (CMR). Patients with overlap syndromes, dyspnea attributable to other cardiac diseases or interstitial lung disease, or any other pulmonary pathology, were excluded. Based on CMR findings, patients were classified as SSc-CMP+ if myocardial damage was detected, or SSc-CMP– if no cardiopulmonary involvement was identified. Continuous variables were compared either by the Student’s t test or the Mann Whitney U test if normally or non-normally distributed, respectively. Categorical variables were compared by means of Fisher’s exact test. Statistical analysis was conducted using IBM SPSS statistics version 29.0.2.0 (20).Results Out of 179 patients included in the analysis, 16 patients (9%) were classified as SSc-CMP+. Compared with the SSc-CMP– group, they exhibited significantly reduced LAS-reservoir (LAS-R) and higher LAS-conduit (LAS-CD) values, while LAS-contractile (LAS-CT) and left atrial volume index were not significantly different. NT-proBNP and troponin T levels were also significantly elevated in SSc-CMP+ patients. Receiver operating characteristic (ROC) analysis demonstrated good discriminatory ability for NT-proBNP (AUC 0.85), LAS-R (AUC 0.81), and LAS-CD (AUC 0.82), whereas LAS-CT did not reach statistical significance. No association was found between SSc-CMP status and specific autoantibody profiles.Conclusions Echocardiographic assessment of LAS represents a noninvasive and practical screening tool for the early identification of SSc patients at risk of primary myocardial involvement. This approach may help guide selective use of CMR in clinical practice. Moreover, our findings indicate that SSc-CMP can occur irrespective of autoantibody status, supporting the need to screen ACA-positive patients when suggestive symptoms are present.Abstract P.157 Figure 1",
  "authors": [
    {
      "affiliations": [
        "Medical Specialty School in Allergology and Clinical Immunology, University of Milan, Milan, Italy"
      ],
      "name": "Martina Iacubino"
    },
    {
      "affiliations": [
        "Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy",
        "Department of Clinical Sciences and Community Health, University of Milan, Dipartimento di Eccellenza 2023-2027, Milan, Italy"
      ],
      "name": "Chiara Bellocchi"
    },
    {
      "affiliations": [
        "Medical Specialty School in Internal Medicine, University of Milan, Milan, Italy"
      ],
      "name": "Emma Lentini"
    },
    {
      "affiliations": [
        "Division of Internal Medicine, Medical Center, Ospedale di Circolo Fondazione Macchi, ASST Sette Laghi, Varese, Italy"
      ],
      "name": "Silvia Tamanini"
    },
    {
      "affiliations": [
        "Cardiology, ASST Rhodense, Milan, Italy"
      ],
      "name": "Giuseppe Locatelli"
    },
    {
      "affiliations": [
        "Department of Cardio-Thoracic-Vascular Diseases, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy"
      ],
      "name": "Marta Mozzo"
    },
    {
      "affiliations": [
        "Department of Clinical Sciences and Community Health, University of Milan, Dipartimento di Eccellenza 2023-2027, Milan, Italy"
      ],
      "name": "Alessandro Quarenghi"
    },
    {
      "affiliations": [
        "Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy",
        "Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy"
      ],
      "name": "Maria De Santis"
    },
    {
      "affiliations": [
        "Scleroderma Clinic, UOC Reumatologia Clinica, ASST Pini-CTO, Milan, Italy"
      ],
      "name": "Nicoletta Del Papa"
    },
    {
      "affiliations": [
        "Scleroderma Unit, Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy"
      ],
      "name": "Giacomo De Luca"
    },
    {
      "affiliations": [
        "Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy"
      ],
      "name": "Lorenzo Beretta"
    },
    {
      "affiliations": [
        "Department of Cardio-Thoracic-Vascular Diseases, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy"
      ],
      "name": "Marco Vicenzi"
    }
  ],
  "title": "P.157 Left atrial strain reveals early myocardial involvement in systemic sclerosis",
  "uid": "0dbcf6c8-6288-5ae9-a086-52a061d85e7d"
}