{
  "abstract": "Introduction Systemic sclerosis (SSc) primary heart involvement (pHI) is common, often subclinical and when symptomatic, portends a poor outcome. Cardiovascular magnetic resonance (CMR) provides multiparametric capability including myocardial perfusion and tissue characterisation. Nailfold capillaroscopy (NFC) provides direct assessment of peripheral microangiopathy. It is unclear whether microvascular injury captured by NFC parallels cardiac pathology.Material and Methods SSc patients without known ischaemic heart disease, SSc-pHI, diabetes or 1 or more traditional cardiovascular risk factor underwent baseline CMR and NFC within 6 months. NFC was classified as either non-specific or early, active, or late and CMR was performed (3 Tesla Philips Achieva MR). Myocardial perfusion reserve was measured (with threshold less than 2.25 employed as abnormal) and abnormal myocardial tissue (MT) defined as the presence of one or more abnormalities: non-ischaemic late gadolinium enhancement (LGE) scar, native T1 more than 1050 ms indicative of diffuse interstitial changes, and/or extracellular volume (ECV) more than 30% of diffuse fibrosis. Continuous variables were compared across NFC groups using ANOVA and categorical variables with χ 2 tests.Results Eighty patients were included (mean age 55 years; 73% female; 32.5% diffuse SSc). Active and late NFC patterns were more common in diffuse cutaneous disease. MPR values were reduced across groups, particularly in early and late patterns (non-specific 2.23 ± 0.86; early 2.13 ± 0.69; active 2.18 ± 0.97; late 2.13 ± 0.72), though differences were not significant. Abnormal MT was present in 40 patients (50%), ranging from 43.5% in non-specific to 63.6% in active NFC. LGE-positive scars occurred at similar frequencies across groups (~35–41%). Native T1 values showed a progressive increase from non-specific to specific patterns (1244 ± 59 ms to 1256 ± 105 ms), while ECV was comparable (29.6–32.0%). NT-proBNP levels were higher in active and late patterns (non-specific 74.9 ± 58.1; early 50.0 ± 85.6; active 100.0 ± 123.2; late 117.8 ± 371.8 pg/mL; p = 0.032).Conclusions Abnormal myocardial perfusion was observed across all NFC groups and appeared most reduced in those with specific NFC patterns. Subclinical myocardial tissue changes, reflected by increased CMR T1 values and higher NT-proBNP, were also noted in these groups. These findings are consistent with the notion of a unified vascular framework, suggesting an association of peripheral and central vasculopathy and myocardial involvement. These data support validation and mechanistic investigation.Abstract P.144 Figure 1a) distribution of T1 native values across NFC patterns: 2) extracellular volume (ECV) across NFC patterns and c) prevalence of abnormal CMR according to NFC patterns and d) myocardial perfusion reserve (MPR) across NFC patternsAbstract P.144 Table 1",
  "authors": [
    {
      "affiliations": [
        "Centre for Musculoskeletal Research, Division of Musculoskeletal & Dermatological Sciences, Manchester, Manchester, United Kingdom"
      ],
      "name": "Cristiana Sieiro Santos"
    },
    {
      "affiliations": [
        "Department of Rheumatology, University Hospital Coventry & Warwickshire NHS Trust, Warwickshire, United Kingdom"
      ],
      "name": "Raluca Bianca Dimitru"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom",
        "Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, LS2 9JT, United Kingdom, Leeds, United Kingdom"
      ],
      "name": "Lesley-Anne Bissel"
    },
    {
      "affiliations": [
        "Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom"
      ],
      "name": "Bara Erhayiem"
    },
    {
      "affiliations": [
        "Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom"
      ],
      "name": "Graham Fent"
    },
    {
      "affiliations": [
        "Rheumatology Institute of Lucania (IReL) and Rheumatology Department of Lucania, San Carlo Regional Hospital, Potenza, Potenza, Italy"
      ],
      "name": "Giuseppina Abignano"
    },
    {
      "affiliations": [
        "Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom"
      ],
      "name": "John Greenwood"
    },
    {
      "affiliations": [
        "Baker Heart and Diabetes Institute, Melbourne, Australia, Melbourne, Australia"
      ],
      "name": "John Biglands"
    },
    {
      "affiliations": [
        "Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom"
      ],
      "name": "Sven Plein"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom"
      ],
      "name": "Francesco Del Galdo"
    },
    {
      "affiliations": [
        "Centre for Musculoskeletal Research, Division of Musculoskeletal & Dermatological Sciences, Manchester, Manchester, United Kingdom",
        "Department of Rheumatology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom"
      ],
      "name": "Maya Buch"
    }
  ],
  "title": "P.144 Subclinical myocardial tissue changes in systemic sclerosis associate with progressive nailfold capillaroscopy patterns",
  "uid": "9248226c-e1bf-538b-817c-740f59312b87"
}