Cardiovascular Imaging Techniques in Systemic Rheumatic Diseases

Abstract

The risk of cardiovascular (CV) events and mortality is significantly higher in patients with systemic rheumatic diseases than in the general population. Although CV involvement in such patients is highly heterogeneous and may affect various structures of the heart, it can now be diagnosed earlier and promptly treated. Various types of assessments are employed for the evaluation of CV risk such as transthoracic or transesophageal echocardiography, magnetic resonance imaging (MRI), and computed tomography (CT) to investigate valve abnormalities, pericardial disease, and ventricular wall motion defects. The diameter of coronary arteries can be assessed using invasive quantitative coronarography or intravascular ultrasound, and coronary flow reserve can be assessed using non-invasive transesophageal or transthoracic ultrasonography (US), MRI, CT, or positron emission tomography (PET) after endothelium-dependent vasodilation. Finally, peripheral circulation can be measured invasively using strain-gauge plethysmography in an arm after the arterial infusion of an endothelium-dependent vasodilator or non-invasively by means of US or MRI measurements of flow-mediated vasodilation of the brachial artery. All of the above are reliable methods of investigating CV involvement, but more recently, introduced use of speckle tracking echocardiography and 3-dimensional US are diagnostically more accurate.

Echocardiography in Autoimmune Rheumatic Diseases for Diagnosis and Prognosis of Cardiovascular Complications

“…The prevalence of valvular abnormalities and other sources of embolism has been reported in up to 61% of patients with antiphospholipid syndrome with higher rates of thromboembolic events associated with higher anticardiolipin antibody titers of >40 GPL units [ 64 ]. Thus, patients with antiphospholipid syndrome and clinical symptoms of peripheral embolism or high anticardiolipin antibody titers should be examined with transoesophageal echo (TOE) [ 65 ].…”

Anti-modified citrullinated vimentin antibody: a novel biomarker associated with cardiac systolic dysfunction in patients with rheumatoid arthritis

“…Risk assessment for CVD can be done by certain clinical, laboratory, and imaging studies. Transthoracic echocardiography (TTE) is a reliable, non-invasive, and inexpensive method that can present signs of previous ischemia, myocardial systolic dysfunction, myocardial diastolic dysfunction, and valvular and pericardial abnormalities [8]. Owing to the high prevalence of echocardiographic markers of diastolic dysfunction among patients with RA, TTE seems to be valuable for the early detection of occult CVD [9].…”