Assessment of myocardial abnormalities in rheumatoid arthritis using a comprehensive cardiac magnetic resonance approach: a pilot study

Abstract

IntroductionRheumatoid arthritis (RA) is a multi-organ inflammatory disorder associated with high cardiovascular morbidity and mortality. We sought to assess cardiac involvement using a comprehensive cardiac magnetic resonance imaging (cMRI) approach and to determine its association with disease characteristics in RA patients without symptomatic cardiac disease.MethodsRA patients with no history and/or clinical findings of systemic or pulmonary hypertension, coronary artery disease, severe valvular heart disease, atrial fibrillation, diabetes mellitus, or echocardiographic abnormalities underwent contrast-enhanced cMRI on a 1.5T scanner. Adenosine triphosphate was used to assess perfusion defects due to microvascular impairment or ischemia, and delayed enhanced imaging was obtained for the assessment of myocardial inflammation/fibrosis. We explored the associations of cMRI abnormalities with RA disease activity and severity measures.ResultsEighteen patients (78% female) with a mean age of 57 ± 10 years were studied. Eight patients (45%) demonstrated a myocardial abnormality. Perfusion defects under pharmacologic stress were seen in two patients (11%), one of whom had a circumferential subendocardial perfusion defect and one had a non-segmental subendocardial perfusion defect. Seven patients (39%) were found to have delayed enhancement, only one of whom also demonstrated a perfusion defect. Mean disease activity score (DAS)28 was significantly higher in the group with delayed enhancement compared to the group without by an average of 1.32 DAS28 units (4.77 vs. 3.44 units, respectively; P = 0.011). Corresponding trends to statistical significance were noted in systemic inflammatory markers, with both C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) quantitatively higher in the group with delayed enhancement. Other RA characteristics, such as disease duration, autoantibody status, and current treatments were not significantly associated with cardiac involvement.ConclusionsMyocardial abnormalities, as detected by cMRI, were frequent in RA patients without known cardiac disease. Abnormal cMRI findings were associated with higher RA disease activity, suggesting a role for inflammation in the pathogenesis of myocardial involvement in RA.

Inflammation and Fibrosis in HIV

“…Similar findings have been reported in other chronic inflammatory conditions such as rheumatoid arthritis. 25, 26 …”

Frequency of fragmented QRS on ECG is increased in patients with rheumatoid arthritis without cardiovascular disease: a pilot study

“…Myocardial late enhancement on contrast-enhanced cardiac magnetic resonance (CMR) imaging occurs in myocardial areas of fibrosis [25]. A CMR imaging study in patients with RA without cardiovascular disease has shown findings that signify myocardial fibrosis in these patients [26,27]. Moreover, it has been reported that the underlying mechanism of diastolic dysfunction in the presence of normal systolic function is myocardial fibrosis [28].…”

Left Ventricular Regional Dysfunction Using Cardiac Magnetic Resonance Imaging in Rheumatoid Arthritis Patients Without Cardiac Symptoms: Comparison Between Methotrexate and Biologics Treatment Groups

“…Our previous study has shown that cardiac abnormalities indicating microvascular and macrovascular coronary ischemia, myocarditis, and/or myocardial fibrosis are frequent in asymptomatic patients with RA, as revealed by pharmacological stress perfusion and delayed-enhanced MRI 9 . Our present study has suggested that nonenhanced CMR with cine MRI, analyzing LV regional function, may be useful to detect subclinical myocardial involvement in RA.…”