Evidence map›Paper›PMID 40614070›Full record

ArticleEuropean journal of clinical investigation2025

First-line diagnostic tests to intercept primary heart involvement in systemic sclerosis: Clinical associations from the SPRING-SIR registry.

Antonio Tonutti, Francesca Motta, Rossella De Angelis, Edoardo Cipolletta, Clodoveo Ferri, Gianluigi Bajocchi, Silvia Bellando-Randone, Cosimo Bruni, Martina Orlandi, Giovanni Zanframundo and 64 more

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Article in European journal of clinical investigation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

74 authors.

Antonio TonuttiDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.ORCID https://orcid.org/0009-0000-9534-6853
Francesca MottaDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
Rossella De AngelisRheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy.
Edoardo CipollettaRheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy.
Clodoveo FerriRheumatology Clinic 'Madonna dello Scoglio', Cotronei, Crotone, Italy.
Gianluigi BajocchiRheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Silvia Bellando-RandoneDivision of Rheumatology, Department of Experimental and Clinical Medicine, AOU Careggi, University of Florence, Florence, Italy.
Cosimo BruniDivision of Rheumatology, Department of Experimental and Clinical Medicine, AOU Careggi, University of Florence, Florence, Italy.
Martina OrlandiDepartment of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena and Reggio Emilia School of Medicine, Modena, Italy.
Giovanni ZanframundoDivision of Rheumatology, IRCCS Foundation Policlinico San Matteo, Pavia, Italy.
Rosario FotiReumatology Unit, AOU Policlinico San Marco, Catania, Italy.
Giovanna CuomoDepartment of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.ORCID https://orcid.org/0000-0002-4292-3589
Alarico ArianiDepartment of Medicine, Internal Medicine and Rheumatology, Azienda Ospedaliero Universitaria di Parma, Parma, Italy.
Edoardo RosatoDepartment of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
Gemma LepriDivision of Rheumatology, Department of Experimental and Clinical Medicine, AOU Careggi, University of Florence, Florence, Italy.
Francesco GirelliRheumatology Unit, Ospedale GB Morgagni, AUSL Romagna, Forlì, Italy.
Elisabetta ZanattaDepartment of Medicine, University of Padua, Padova, Italy.
Silvia Laura BoselloDivision of Rheumatology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Ilaria CavazzanaRheumatology and Clinical Immunology, ASST Spedali Civili of Brescia; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Francesca IngegnoliDivision of Clinical Rheumatology, ASST Pini, Department of Clinical Sciences & Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università Degli Studi di Milano, Milan, Italy.
Fabio CacciapagliaRheumatology Unit, Department of Precision and Regenerative Medicine, Area Jonica (DiMePRe-J), University of Bari, Bari, Italy.
Giuseppe MurdacaDepartment of Internal Medicine, University of Genoa, Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Giuseppina AbignanoDepartment of Health of Science, University of Basilicata, Potenza, Italy.
Giorgio PettitiRheumatology Unit, S. Croce e Carle Hospital, Cuneo, Italy.
Alessandra Della RossaDepartment of Rheumatology, University of Pisa, Pisa, Italy.
Maurizio CaminitiDepartmental Rheumatology Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy.
Anna Maria IulianoRheumatology Unit, San Camillo-Forlanini Hospital, Rome, Italy.
Giovanni CianoLocal Health Department, Ariano Irpino Hospital, Avellino, Italy.
Lorenzo BerettaReferral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy.
Gianluca BagnatoDepartment of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Ennio LubranoDepartment of Rheumatology, University of Molise, Campobasso, Italy.
Ilenia De AndresRheumatology Unit, Azienda Ospedaliera di Rilievo Nazionale Ed Alta Specializzazione Garibaldi, Catania, Italy.
Luca IdolazziRheumatology Section, Department of Medicine, University of Verona, Verona, Italy.
Marta SaraccoRheumatology Unit, Mauriziano-Umberto I Hospital, Turin, Italy.
Cecilia AgnesDepartment of Medicine, Division of Rehabilitation, Turin, ASL TO5, Carmagnola, Italy.
Corrado CampochiaroUnit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), & Inflammation, Fibrosis and Ageing Initiative (INFLAGE), IRCCS San Raffaele Hospital, Milan, Italy.
Marco FornaroVita-Salute San Raffaele University, Milan, Italy.ORCID https://orcid.org/0000-0003-1716-7432
Federica LumettiDepartment of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena and Reggio Emilia School of Medicine, Modena, Italy.
Amelia SpinellaDepartment of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena and Reggio Emilia School of Medicine, Modena, Italy.
Luca MagnaniRheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Giacomo De LucaUnit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), & Inflammation, Fibrosis and Ageing Initiative (INFLAGE), IRCCS San Raffaele Hospital, Milan, Italy.
Veronica CodulloDivision of Rheumatology, IRCCS Foundation Policlinico San Matteo, Pavia, Italy.
Elisa VisalliReumatology Unit, AOU Policlinico San Marco, Catania, Italy.
Carlo IandoliDepartment of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
Antonietta GiganteDepartment of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
Greta PellegrinoDepartment of Clinical, Internal, Anesthesiologic and Cardiological Sciences, Sapienza University of Rome, Rome, Italy.
Erika PigattoDepartment of Medicine, Villa Salus Hospital, Venice, Italy.
Maria Grazia LazzaroniRheumatology and Clinical Immunology, ASST Spedali Civili of Brescia; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Enrico De LorenzisDivision of Rheumatology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Gianna MennilloDepartment of Health of Science, University of Basilicata, Potenza, Italy.
Marco Di BattistaDepartment of Rheumatology, University of Pisa, Pisa, Italy.ORCID https://orcid.org/0000-0002-4788-5729
Giuseppa Pagano-MarianoDepartmental Rheumatology Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy.
Federica FuriniRheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria S. Anna di Ferrara, Ferrara, Italy.
Licia VultaggioRheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria S. Anna di Ferrara, Ferrara, Italy.
Simone ParisiRheumatology Unit, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza, Turin, Italy.
Clara Lisa PeroniRheumatology Unit, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza, Turin, Italy.
Gerolamo BianchiRheumatology Unit, Department of Medical Specialities, Local Health Trust 3, Genoa, Italy.
Enrico FusaroRheumatology Unit, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza, Turin, Italy.
Gian Domenico SebastianiRheumatology Unit, San Camillo-Forlanini Hospital, Rome, Italy.
Marcello GovoniRheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria S. Anna di Ferrara, Ferrara, Italy.
Salvatore D'AngeloDepartment of Health of Science, University of Basilicata, Potenza, Italy.
Franco CozziDepartment of Medicine, Villa Salus Hospital, Venice, Italy.
Franco FranceschiniRheumatology and Clinical Immunology, ASST Spedali Civili of Brescia; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Serena GuiducciDivision of Rheumatology, Department of Experimental and Clinical Medicine, AOU Careggi, University of Florence, Florence, Italy.
Lorenzo DagnaUnit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), & Inflammation, Fibrosis and Ageing Initiative (INFLAGE), IRCCS San Raffaele Hospital, Milan, Italy.
Andrea DoriaDepartment of Medicine, University of Padua, Padova, Italy.
Dilia GiuggioliDepartment of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena and Reggio Emilia School of Medicine, Modena, Italy.
Valeria RiccieriDepartment of Clinical, Internal, Anesthesiologic and Cardiological Sciences, Sapienza University of Rome, Rome, Italy.
Carlo SalvaraniAzienda USL-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy.
Florenzo IannoneRheumatology Unit, Department of Precision and Regenerative Medicine, Area Jonica (DiMePRe-J), University of Bari, Bari, Italy.ORCID https://orcid.org/0000-0003-0474-5344
Marco Matucci-CerinicUnit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), & Inflammation, Fibrosis and Ageing Initiative (INFLAGE), IRCCS San Raffaele Hospital, Milan, Italy.
Carlo SelmiDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
Maria De SantisDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
SPRING‐SIR (Systemic Sclerosis PRogression INvestiGation group of the Italian Society for Rheumatology)

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionPrimary heart involvement (pHI) is an overlooked and poorly characterised complication of systemic sclerosis (SSc), associated with the risk of heart failure, arrhythmia and death. Despite consensus definition by the World Scleroderma Foundation/Heart Failure Association (WSF/HFA), diagnostic criteria and risk factors remain poorly elucidated.

methodsOut of 1922 patients in the Italian national SPRING registry, we excluded those with potentially confounding conditions according to WSF/HFA, and those with incomplete ECG or echocardiographic assessment, resulting in 600 subjects with clearly defined parameters to intercept SSc-pHI. Cross-sectional and longitudinal analyses were performed to identify factors associated with pHI.

resultsECG and/or echocardiographic signs of SSc-pHI were identified in 25% of patients at enrollment and were associated with older age (OR 1.04; 95% CI 1.02-1.06), diffuse cutaneous SSc (OR 1.85; 95% CI 1.05-3.26) and intestinal symptoms (OR 1.79; 95% CI 1.03-3.08). Diastolic dysfunction (62%) and conduction disturbances (34%) were the most frequent phenotypes, while diffuse hypokinesia with reduced ejection fraction was the least common (3%). During follow-up, new-onset signs of pHI were observed in an additional 25% of patients, particularly in those with skeletal muscle involvement (HR 2.83; 95% CI 1.01-7.73).

conclusionspHI is a severe complication potentially affecting one-quarter of patients with SSc. Early detection is crucial, particularly in those with diffuse skin fibrosis, muscular involvement and intestinal manifestations.

Indexed as

Scleroderma, SystemicAdultAgedAge FactorsArrhythmias, CardiacCross-Sectional StudiesEchocardiographyElectrocardiographyFemaleHeart FailureHumansItalyLongitudinal StudiesMaleMiddle AgedRegistriesautoimmunityconnective tissue diseaseechocardiographyimmunologyrisk factorssystemic sclerosis

Identifiers

PMID40614070
PMCPMC12621291

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