S. Mavrogeni, A. Pepe, K. R. Nijveldt, N. Ntusi, L.M. Sierra-Galan, Bratis, J. Wei, M. Mukherjee, G. Markousis-Mavrogenis, L. Gargani, L.E. Sade, N. Ajmone-Marsan, M. P. Seferovic, E. Donal, Nurmohamed, M. Matucci Cerinic, P. Sfikakis, G. Kitas, J. Schwitter, J. A. C. Lima, Dana Dawson, Marc Dweck, Kristina H. Haugaa, Niall Keenan, James Moon, Ivan Stankovic, Erwan Donal, Bernard Cosyns
Onassis Cardiac Surgery Center. National and Kapodistrian University of Athens. University of Padua. Radboud University Medical Center. University of Cape Town and Groote Schuur Hospital. American British Cowdray Medical Center. Manchester Royal Infirmary. Cedars-Sinai Smidt Heart Institute. Johns Hopkins University School of Medicine. University of Pisa. University of Pittsburgh Medical Center. Baskent University. Leiden University Medical Center. Belgrade University. Amsterdam University Medical Centers. University of Florence. San Raffaele Hospital. Laikon Hospital and Athens University Medical School. Manchester University. Lausanne University Hospital.
Multiple Countries
European Heart Journal Cardiovascular Imaging
Eur Heart J Cardiovasc Imaging 2022; 23: e308-e322
DOI: 10.1093/ehjci/jeac134
Abstract
Autoimmune rheumatic diseases (ARDs) involve multiple organs including the heart and vasculature. Despite novel treatments, patients with ARDs still experience a reduced life expectancy, partly caused by the higher prevalence of cardiovascular disease (CVD). This includes CV inflammation, rhythm disturbances, perfusion abnormalities (ischaemia/infarction), dysregulation of vasoreactivity, myocardial fibrosis, coagulation abnormalities, pulmonary hypertension, valvular disease, and side-effects of immunomodulatory therapy. Currently, the evaluation of CV involvement in patients with ARDs is based on the assessment of cardiac symptoms, coupled with electrocardiography, blood testing, and echocardiography. However, CVD may not become overt until late in the course of the disease, thus potentially limiting the therapeutic window for intervention. More recently, cardiovascular magnetic resonance (CMR) has allowed for the early identification of pathophysiologic structural/functional alterations that take place before the onset of clinically overt CVD. CMR allows for detailed evaluation of biventricular function together with tissue characterization of vessels/myocardium in the same examination, yielding a reliable assessment of disease activity that might not be mirrored by blood biomarkers and other imaging modalities. Therefore, CMR provides diagnostic information that enables timely clinical decision-making and facilitates the tailoring of treatment to individual patients. Here we review the role of CMR in the early and accurate diagnosis of CVD in patients with ARDs compared with other non-invasive imaging modalities. Furthermore, we present a consensus-based decision algorithm for when a CMR study could be considered in patients with ARDs, together with a standardized study protocol. Lastly, we discuss the clinical implications of findings from a CMR examination.
Category
Consensus Guidelines for Pulmonary Vascular Disease
Class I. Pulmonary Hypertension Associated with Connective Tissue Disease
Diagnostic Testing for Pulmonary Vascular Disease. Non-invasive Testing
Age Focus: Pediatric Pulmonary Vascular Disease or Adult Pulmonary Vascular Disease
Fresh or Filed Publication: Filed (PHiled). Greater than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes