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Background: Cardiovascular MRI (CMR) abnormalities can be detected in people with rheumatoid arthritis (RA) and systemic sclerosis (SSc) in the absence of cardiac symptoms. Commonly measured serum cardiac markers, troponin (Tn) and N-terminal-pro-brain natriuretic peptide (NT-proBNP), have also been reported but the relationship between subclinical abnormalities on CMR and these standard biomarkers remains unclear.
Objectives: To determine whether high sensitivity (hs)-TnI and NT-proBNP correlate with subclinical CMR vascular and/or myocardial tissue abnormalities in RA and SSc cohorts.
Methods: Two separate cohorts of individuals with early, untreated, active RA (N = 75) and SSc (N = 78), with no history of cardiovascular involvement and with low cardiovascular risk (maximum 1 traditional risk factor for RA and 2 for SSc) underwent CMR and had corresponding levels of hs-TnI (ng/L) and NT-pro-BNP (pg/ml) measured [1,2] . A concentration greater than 37 ng/mL for hs-TnI and greater than 125 ng/mL for NT-proBNP were identified as abnormal. The following CMR measures were obtained: aortic distensibility and pulse wave velocity, and myocardial tissue measures, native T1, myocardial extracellular volume, and late gadolinium enhancement. Age and sex-matched normal distributions for CMR measures were obtained from the published CMR reference ranges [3] . Descriptive statistics are reported.
Results: Table 1 outlines baseline demographics and disease characteristics of the two cohorts. All RA individuals recruited had moderate-high disease activity as per eligibility criteria.
CMR abnormalities were detected in 32/75 (43%) patients with RA of which 7 (22%) had an elevated hs-TnI and 7/32 (22%) had an elevated NT-ProBNP. A higher proportion of SSc patients had evidence of any CMR abnormality [63/78 (80%)] of which 20/63 (31%) and 7/59 (12%) had an elevated hs-TnI and NT-ProBNP respectively.
In individuals with a normal CMR, 7/43 (16%) had elevated hs-TnI and 4/43 (9%) had an elevated NT-ProBNP in RA. Whilst in the SSc cohort, 1/15 (7%) had an elevated hs-TnI and 2/15 (13%) had an elevated NT-ProBNP.
Baseline demographics and characteristics between RA and SSc cohorts.
| Characteristic | Rheumatoid Arthritis (RA)
| Systemic Sclerosis (SSc)
|
|---|---|---|
| Age (yrs) a | 51.00 (40.00, 60.50) | 54.00 (49.00, 62.75) |
| Female b | 52 (69%) | 65 (83%) |
| Current/ex-smokers b | 40 (53%) | 27 (36%) |
| BMI (kg/m2) a | 26.39 (23.31, 28.03) | 23.93 (21.50, 28.71) |
| Hypertension b | 6 (8.0%) | 8 (10%) |
| CRP (mg/dl)
a
| 8.38 (2.30, 20.48) | 5.00 (5.00, 5.00) |
| Modified Rodnan skin score a | - | 2.00 (1.00, 5.75) |
| Anti-Scl 70 antibody b | - | 23 (29%) |
| Anti-centromere antibody b | - | 25 (32%) |
| DAS28-ESR a | 5.51 (4.88, 6.40) | - |
| Rheumatoid Factor and/or Anti-CCP positive b | 67 (89%) | -
|
aMedian (IQR), bn (%)
Conclusion: A considerable proportion of individuals with RA or SSc and subclinical vascular and/or myocardial CMR abnormality have normal serum cardiac enzymes. These findings suggest standard serum cardiac biomarker driven stratification to identify subclinical cardiovascular involvement may be insufficient.
REFERENCES: [1] Plein, S. et al. Using cardiovascular magnetic resonance to define mechanisms of comorbidity and to measure the effect of biological therapy: the CADERA observational study. Efficacy and Mechanism Evaluation 8 , 1–42 (2021).
[2] Dumitru, R. B. et al. Cardiovascular outcomes in systemic sclerosis with abnormal cardiovascular MRI and serum cardiac biomarkers. RMD Open 7 , (2021).
[3] Kawel-Boehm, N. et al. Reference ranges (“normal values”) for cardiovascular magnetic resonance (CMR) in adults and children: 2020 update. Journal of Cardiovascular Magnetic Resonance 22 , 87 (2020).
Acknowledgements: NIL.
Disclosure of Interests: None declared.