Brief report: successful pregnancies but a higher risk of preterm births in patients with systemic sclerosis: an Italian multicenter study.

OBJECTIVE: To assess fetal and maternal outcomes in women with systemic sclerosis (SSc). METHODS: Prospectively collected data on 99 women with SSc from 25 Italian centers were analyzed retrospectively. Women with SSc were observed during 109 pregnancies (from 2000 to 2011), and outcomes were compared to those in the general obstetric population (total of 3,939 deliveries). The maternal age at conception was a mean ± SD 31.8 ± 5.3 years, and the median disease duration at conception was 60 months (range 2-193 months). RESULTS: SSc patients, compared to the general obstetric population, had a significantly increased frequency of preterm deliveries (25% versus 12%) and severe preterm deliveries (<34 weeks of gestation) (10% versus 5%), intrauterine growth restriction (6% versus 1%), and babies with very-low birth weight (5% versus 1%). Results of multivariable analysis showed that corticosteroid use was associated with preterm deliveries (odds ratio [OR] 3.63, 95% confidence interval [95% CI] 1.12-11.78), whereas the use of folic acid (OR 0.30, 95% CI 0.10-0.91) and presence of anti-Scl-70 antibodies (OR 0.26, 95% CI 0.08-0.85) were protective. The disease remained stable in most SSc patients, but there were 4 cases of progression of disease within 1 year from delivery, all in anti-Scl-70 antibody-positive women, 3 of whom had a disease duration of <3 years. CONCLUSION: Women with SSc can have successful pregnancies, but they have a higher-than-normal risk of preterm delivery, intrauterine growth restriction, and babies with very-low birth weight. Progression of the disease during or after pregnancy is rare, but possible. High-risk multidisciplinary management should be standard for these patients, and pregnancy should be avoided in women with severe organ damage and postponed in women with SSc of recent onset, particularly if the patient is positive for anti-Scl-70 antibodies.

Decompensated chronic heart failure: increased liver stiffness measured by means of transient elastography.

PURPOSE: To analyze transient elastography-measured liver stiffness in patients with acute decompensated heart failure to describe variations in liver stiffness measurements and assess their relationship with the patients' clinical course and laboratory data. MATERIALS AND METHODS: This study was approved by the local institutional review board, and all of the subjects gave verbal informed consent. Twenty-seven hospitalized patients with heart failure with no signs of liver disease (mean age, 79 years ± 12 [standard deviation]; 12 men [mean age, 78 years ± 11], 15 women [mean age, 80 years ± 12]) underwent liver stiffness and N-terminal proß brain natriuretic peptide (NTproßBNP) assessments at admission, and 24 patients underwent stiffness measurements at discharge. (Three patients had failed measurement at admission; two of whom did not undergo measurement at discharge and one patient who died had only an admission value obtained.) The predefined stiffness cutoff values were greater than 7.65 kPa for substantial fibrosis and greater than 13.01 kPa for cirrhosis. The control subjects were 21 patients unaffected by heart failure or liver disease. The two groups were compared by using two-tailed Wilcoxon, Mann-Whitney, or t tests, as appropriate. RESULTS: Among the patients with heart failure, median liver stiffness at admission was 8.80 kPa (interquartile range, 5.92-11.90 kPa), greater than 7.65 kPa in 14 (58%) cases and greater than 13.01 kPa in five (21%). During hospitalization, liver stiffness decreased in 18 patients (including all five patients with baseline measurement > 13.01 kPa) and increased in five. Median liver stiffness (P < .003) and NTproßBNP (P < .001) levels both significantly decreased during hospitalization. Liver stiffness was less than 7.65 kPa in all control patients and did not significantly change during hospitalization (P = .261). CONCLUSION: Most patients with acute decompensated heart failure have high liver stiffness values which, like NTproßBNP levels, tend to decrease with clinical improvement. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100013/-/DC1.