Cardiac MRI in Autoimmune Diseases: Where Are We Now?

Geladari, Eleni; Panagopoulos, Fotis; Kalantzi, Maria

doi:10.2174/1573403x16666210108104236

Cited by 4 publications

(4 citation statements)

References 60 publications

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“…There are a lot of recent publications on how CMR can add value to risk stratification and the management of patients with ARDs. For example, the presence of late gadolinium enhancement (LGE) on CMR is related to a worse cardiovascular prognosis in these patients ( 118 ). Some studies suggest that edema/fibrosis visualization with CMR may have the potential to inform cardiac and rheumatic treatment modification in ARDs with or without abnormal routine cardiac evaluation.…”

Section: Cmr Signatures For Risk Stratification Prognostication and G...mentioning

confidence: 99%

Cardiac magnetic resonance assessment of cardiac involvement in autoimmune diseases

Gulhane,

Ordovas

2023

Front. Cardiovasc. Med.

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Cardiac magnetic resonance (CMR) is emerging as the modality of choice to assess early cardiovascular involvement in patients with autoimmune rheumatic diseases (ARDs) that often has a silent presentation and may lead to changes in management. Besides being reproducible and accurate for functional and volumetric assessment, the strength of CMR is its unique ability to perform myocardial tissue characterization that allows the identification of inflammation, edema, and fibrosis. Several CMR biomarkers may provide prognostic information on the severity and progression of cardiovascular involvement in patients with ARDs. In addition, CMR may add value in assessing treatment response and identification of cardiotoxicity related to therapy with immunomodulators that are commonly used to treat these conditions. In this review, we aim to discuss the following objectives: •Illustrate imaging findings of multi-parametric CMR approach in the diagnosis of cardiovascular involvement in various ARDs;•Review the CMR signatures for risk stratification, prognostication, and guiding treatment strategies in ARDs;•Describe the utility of routine and advanced CMR sequences in identifying cardiotoxicity related to immunomodulators and disease-modifying agents in ARDs;•Discuss the limitations of CMR, recent advances, current research gaps, and potential future developments in the field.

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Section: Cmr Signatures For Risk Stratification Prognostication and G...mentioning

confidence: 99%

Cardiac magnetic resonance assessment of cardiac involvement in autoimmune diseases

Gulhane,

Ordovas

2023

Front. Cardiovasc. Med.

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“…Plus, the presence of late gadolinium enhancement (LGE) has been linked to a worse cardiovascular prognosis in various patient populations. CMR is an important tool in the diagnosis and risk prediction for patients with sarcoidosis and could help narrow the gap between clinical and autopsy diagnosis of myocardial involvement in patients with SLE ( 40 ). CMR is surely helpful in the early detection of CVD risk, however, the considerable cost and limited availability have to be taken into account, as well as the need to perform clinical prospective trials in order to assess the specific parameters that affect CVD prognosis.…”

Section: Cardiovascular Imaging: Detecting Subtle Changesmentioning

confidence: 99%

Novel Surrogate Markers of Cardiovascular Risk in the Setting of Autoimmune Rheumatic Diseases: Current Data and Implications for the Future

et al. 2022

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Patients suffering from rheumatologic diseases are known to have an increased risk for cardiovascular disease (CVD). Although the pathological mechanisms behind this excess risk have been increasingly better understood, there still seems to be a general lack of consensus in early detection and treatment of endothelial dysfunction and CVD risk in patients suffering from rheumatologic diseases and in particular in those who haven't yet shown symptoms of CVD. Traditional CVD prediction scores, such as Systematic Coronary Risk Evaluation (SCORE), Framingham, or PROCAM Score have been proposed as valid assessment tools of CVD risk in the general population. However, these risk calculators developed for the general population do not factor in the effect of the inflammatory burden, as well as other factors that can increase CVD risk in patients with rheumatic diseases, such as glucocorticoid therapy, abnormal lipoprotein function, endothelial dysfunction or accelerated atherosclerosis. Thus, their sole use could lead to underestimation of CVD risk in patients with rheumatic diseases. Therefore, there is a need for new biomarkers which will allow a valid and early assessment of CVD risk. In recent years, different research groups, including ours, have examined the value of different CVD risk factors such as carotid sonography, carotid-femoral pulse wave velocity, flow-mediated arterial dilation and others in the assessment of CVD risk. Moreover, various novel CVD laboratory markers have been examined in the setting of autoimmune diseases, such as Paraoxonase activity, Endocan and Osteoprotegerin. Dyslipidemia in rheumatoid arthritis (RA) is for instance better quantified by lipoproteins and apolipoproteins than by cholesterol levels; screening as well as pre-emptive carotid sonography hold promise to identify patients earlier, when prophylaxis is more likely to be effective. The early detection of subtle changes indicating CVD in asymptomatic patients has been facilitated through improved imaging methods; the inclusion of artificial intelligence (AI) shows promising results in more recent studies. Even though the pathophysiology of coronary artery disease in patients with autoimmune rheumatic diseases has been examined in multiple studies, as we continuously gain an increased understanding of this comorbidity, particularly in subclinical cases we still seem to fail in the stratification of who really is at risk—and who is not. A the time being, a multipronged and personalized approach of screening patients for traditional CVD risk factors, integrating modern imaging and further CV diagnostic tools and optimizing treatment seems to be a solid approach. There is promising research on novel biomarkers, likewise, methods using artificial intelligence in imaging provide encouraging data indicating possibilities of risk stratification that might become gold standard in the near future. The present review concentrates on showcasing the newest findings concerning CVD risk in patients with rheumatologic diseases and aims to evaluate screening methods in order to optimize CVD risk evaluation and thus avoiding underdiagnosis and undertreatment, as well as highlighting which patient groups are most at risk.

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“…100 It also provides critical data on myocardial viability, and basic tissue characterization including noninvasive confirmation of infiltrative and autoimmune diseases impacting the myocardium such as amyloid, lupus, sarcoid, and Fabry's disease. 102,103 Given the pleiotropic pathologic alterations of HF, CMR may be used to show the earliest changes in the essential basic metrics distinguishing between normal age-related changes and those associated with HFpEF risk factors. 64,[104][105][106][107][108] Also, it may have a potential role in identifying diverse phenotypes within the HFpEF patient population using combined information from CMR.…”

Section: Cmr Combined With Echocardiography: Beyond Cardiac Fibrosismentioning

confidence: 99%

Section: Cmr Combined With Echocardiography: Beyond Cardiac Fibrosismentioning

confidence: 99%

Heart Failure With Preserved Ejection Fraction: Will Cardiac Magnetic Imaging Impact on Diagnosis, Treatment, and Outcomes?: Explaining the Need for Advanced Imaging to Clinical Stakeholders

Moreyra

Rozich³

2022

Cardiology in Review

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Clinicians frequently equate symptoms of volume overload to heart failure (HF) but such generalization may preclude diagnostic or etiologic precision essential to optimizing outcomes. HF itself must be specified as the disparate types of cardiac pathology have been traditionally surmised by examination of left ventricular (LV) ejection fraction (EF) as either HF with preserved LVEF (HFpEF-LVEF >50%) or reduced LVEF of (HFrEF-LVEF <40%). More recent data support a third, potentially transitional HF subtype, but therapy, assessment, and prognosis have been historically dictated within the corresponding LV metrics determined by echocardiography. The present effort asks whether this historically dominant role of echocardiography is now shifting slightly, becoming instead a shared if not complimentary test. Will there be a gradual increasing profile for cardiac magnetic resonance as the attempt to further refine our understanding, diagnostic accuracy, and outcomes for HFpEF is attempted?

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Cardiac MRI in Autoimmune Diseases: Where Are We Now?

Cited by 4 publications

References 60 publications

Cardiac magnetic resonance assessment of cardiac involvement in autoimmune diseases

Cardiac magnetic resonance assessment of cardiac involvement in autoimmune diseases

Novel Surrogate Markers of Cardiovascular Risk in the Setting of Autoimmune Rheumatic Diseases: Current Data and Implications for the Future

Heart Failure With Preserved Ejection Fraction: Will Cardiac Magnetic Imaging Impact on Diagnosis, Treatment, and Outcomes?: Explaining the Need for Advanced Imaging to Clinical Stakeholders

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