Heart, Kidney Imaging Could Detect Fibrosis in Scleroderma, Study Finds

Heart and kidney imaging may help detect fibrosis, or scarring, in asymptomatic people with scleroderma, and could be useful in routine evaluations for people with the disease, a study suggests.

The study, “Late Gadolinium Enhancement in Cardiac Magnetic Resonance Imaging Is Associated with High Renal Resistive Index in Patients with Systemic Sclerosis,” was published in the journal Kidney and Blood Pressure Research.

Scleroderma may result in dysfunction and fibrosis in multiple organ systems, most commonly the heart and kidneys. Yet the involvement of these organs may be underestimated, particularly in people who don’t show symptoms.

Researchers from Sapienza University of Rome evaluated the hearts and kidneys of 26 people with scleroderma, with a median age 42. Sixteen of them had diffuse cutaneous scleroderma, and 10 had limited cutaneous scleroderma. All were being treated with nifedipine, which was discontinued prior to organ imaging.

Hearts were assessed using cardiac magnetic resonance (CMR). Researchers were looking for late gadolinium enhancement (LGE), which indicates scarred heart tissue.

Results showed LGE in 16 participants (61.5%).

Kidneys were assessed with renal Doppler ultrasound (RDU) to measure renal resistive index (RRI), pulsatility index (PI), and systolic/diastolic blood pressure ratio. These parameters indicate the “stiffness” of blood vessels within the kidneys, with greater stiffness related to kidney damage. RRI in particular is a known risk factor for more severe disease in scleroderma, and appears to be a marker of fibrosis both for renal and systemic involvement.

For all three kidney-related measurements, the median value was significantly higher among individuals with LGE in the heart tissue than in those without it: 0.68 compared with 0.64 for RRI, 1.37 versus 1.12 for PI, and 3.12 versus 2.78 for systolic/diastolic blood pressure ratio.

“Our data showed that intrarenal parameters and LGE could be diagnostic markers of fibrosis in asymptomatic SSc [scleroderma] patients,” the researchers wrote, although they noted that the number of participants in the study was small.

“CMR with LGE and RRI are noninvasive, nonradiating methods to timely detect cardiorenal involvement in SSc, and it could be useful to add them in the routine evaluation,” they said. “Early detection of pathological findings in asymptomatic SSc patients is important to avoid further complications and allows specific therapy.”