Early detection of myocardial and pulmonary oedema with mri in an asymptomatic systemic sclerosis patient: Successful recovery with pulse steroid

摘要

Sir, Cardiac involvement is frequent in SSc, accounting for a substantial proportion of the mortality of the disease [1]. In these patients, cardiac involvement is usually asymptomatic, but when it becomes clinically evident, extensive damage to the myocardium is already established and the treatment is rarely effective. These patients are exposed to the risk of sudden death due to malignant arrhythmias [2], therefore an early diagnosis is of paramount importance. MRI has been demonstrated to be useful in the detection of subclinical heart involvement [3-5].A 29-year-old woman was diagnosed in 2009 with SSc and referred to our centre. She presented with a modified Rodnan skin score of 22, positive to ANAs and anti-topoisomerase antibodies, forced vital capacity 83.8%, carbon monoxide diffusion capacity (DLpo) 54% and DLco corrected for alveolar volume (DLCO/VA) 64.2%. Chest high-resolution CT showed ground glass areas in the inferior lobes and in the basal portion of the middle lobe. An echocardiogram showed normal global and regional systolic function and normal diastolic function of both right and left ventricle, without any valvular abnormality. As a participant in the SCLAIRE study, the patient underwent a cardiac MRI. The study was approved by the local ethics committee of Pisa (Comitato Etico Locale della Azienda Ospedaliera Universitaria Pisana, Italy,protocol no. 2849). The patient's written informed consent was obtained according to the Declaration of Helsinki.