Cardiac Tissue Characterization and Imaging in Autoimmune Rheumatic Diseases

Mavrogeni, Sophie; Sfikakis, Petros P.; Κουτσογεωργοπούλου, Λουκία; Markousis‐Mavrogenis, George; Dimitroulas, Theodoros; Kolovou, Genovefa; Kitas, George D.

doi:10.1016/j.jcmg.2017.08.017

Cited by 31 publications

(37 citation statements)

References 77 publications

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“…However, echocardiography remains the most common cardiac imaging procedure performed in clinical practice, due to its portability, low cost, and patient acceptance. Although often not recognized as such [3], tissue characterisation is already performed using echocardiography – a thinned and akinetic myocardium signifies transmural myocardial fibrosis, for instance, and there is significant research into ultrasonic backscatter. However, more advanced echocardiography methods, providing additional information on the structure and function of the underlying tissue, could be used in both translational and clinical research, and ultimately translated to clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Myocardial tissue characterisation using echocardiographic deformation imaging

Moharram

Lamberts

Whalley

et al. 2019

Cardiovasc Ultrasound

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Myocardial pathology results in significant morbidity and mortality, whether due to primary cardiomyopathic processes or secondary to other conditions such as ischemic heart disease. Cardiac imaging techniques characterise the underlying tissue directly, by assessing a signal from the tissue itself, or indirectly, by inferring tissue characteristics from global or regional function. Cardiac magnetic resonance imaging is currently the most investigated imaging modality for tissue characterisation, but, due to its accessibility, advanced echocardiography represents an attractive alternative. Speckle tracking echocardiography (STE) is a reproducible technique used to assess myocardial deformation at both segmental and global levels. Since distinct myocardial pathologies affect deformation differently, information about the underlying tissue can be inferred by STE. In this review, the current available studies correlating STE deformation parameters with underlying tissue characteristics in humans are examined, with separate emphasis on global and segmental analysis. The current knowledge is placed in the context of integrated backscatter and the future of echocardiographic based tissue characterisation is discussed. The use of these imaging techniques to more precisely phenotype myocardial pathology more precisely will allow the design of translational cardiac research studies and, potentially, tailored management strategies.

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Section: Introductionmentioning

confidence: 99%

Myocardial tissue characterisation using echocardiographic deformation imaging

Moharram

Lamberts

Whalley

et al. 2019

Cardiovasc Ultrasound

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“…Cardiovascular magnetic resonance imaging (CMR) is a non-invasive, non-ionizing radiation imaging modality that can assess cardiac geometry and function, myocardial perfusion and fibrosis [10,11]. Only one previous study used CMR in APS that showed a significantly higher prevalence of occult myocardial fibrosis associated with microvascular disease, expressed as late gadolinium enhancement (LGE), in 27 patients with APS compared to 81 healthy controls [12].…”

Section: Introductionmentioning

confidence: 99%

Silent Myocardial Perfusion Abnormalities Detected by Stress Cardiovascular Magnetic Resonance in Antiphospholipid Syndrome: A Case-Control Study

Mavrogeni

Markousis‐Mavrogenis

Karapanagiotou

et al. 2019

JCM

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Objective: To examine the prevalence of silent myocardial ischemia and fibrosis in antiphospholipid syndrome (APS), using stress cardiovascular magnetic resonance (CMR). Methods: Forty-four consecutive APS patients without prior cardiac disease (22 primary APS, 22 systemic lupus erythematosus (SLE)/APS, mean age 44 (12.9) years, 64% women) and 44 age/gender-matched controls were evaluated using CMR at 1.5 T. Steady-state free precession imaging for function assessment and adenosine stress-CMR for perfusion-fibrosis evaluation were employed. The myocardial perfusion reserve index (MPRI), and myocardial fibrosis expressed as late gadolinium enhancement (LGE), were evaluated. Coronary angiography was indicated in patients with LGE. Associations with APS characteristics, classic cardiovascular disease (CVD) risk factors, high-sensitivity CRP (hs-CRP) and high-sensitivity Troponin (hs-TnT) levels were tested. All patients were followed up for 12 months. Results: Median MPRI was significantly lower in APS patients versus controls [1.5 (0.9–1.9) vs. 2.7 (2.2–3.2), p < 0.001], independently of any LGE presence. LGE was detected in 16 (36.3%) patients versus none of controls (p < 0.001); 12/16 were subsequently examined with coronary angiography and only two of them had coronary artery lesions. In multivariable analysis, none of the APS-related and classic CVD risk factors, or hs-CRP and hs-TnT covariates, were significant predictors of abnormal MPRI or LGE. At the twelve month follow-up, three (6.8%) patients experienced coronary artery disease, notably those with the lowest MPRI values. Conclusions: Abnormal MPRI and LGE are common in asymptomatic APS patients, independently so of any APS-related and classic CVD risk factors, or coronary angiography findings in cases with LGE. Stress-CMR is a valuable tool to detect silent myocardial ischemia and fibrosis in APS.

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“…The findings of this investigation have important implications for the clinical evaluation and management of ARD patients. Next to the known additive value of CMR in the evaluation of ARD patients with cardiovascular symptoms [53], this investigation demonstrates that brain MRI identified WMHs in the vast majority of ARD patients. MRI is the only non-invasive imaging modality that can evaluate both the heart and the brain without employing ionizing radiation.…”

Section: Discussionmentioning

confidence: 68%

Combined Brain-Heart Magnetic Resonance Imaging in Autoimmune Rheumatic Disease Patients with Cardiac Symptoms: Hypothesis Generating Insights from a Cross-Sectional Study

Markousis‐Mavrogenis

Mitsikostas

Κουτσογεωργοπούλου

et al. 2020

JCM

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Background: Autoimmune rheumatic diseases (ARDs) may affect both the heart and the brain. However, little is known about the interaction between these organs in ARD patients. We asked whether brain lesions are more frequent in ARD patients with cardiac symptoms compared with non-ARD patients with cardiovascular disease (CVD). Methods: 57 ARD patients with mean age of 48 ± 13 years presenting with shortness of breath, chest pain, and/or palpitations, and 30 age-matched disease-controls with non-autoimmune CVD, were evaluated using combined brain–heart magnetic resonance imaging (MRI) in a 1.5T system. Results: 52 (91%) ARD patients and 16 (53%) controls had white matter hyperintensities (p < 0.001) in at least one brain area (subcortical/deep/periventricular white matter, basal ganglia, pons, brainstem, or mesial temporal lobe). Only the frequency and number of subcortical and deep white matter lesions were significantly greater in ARD patients (p < 0.001 and 0.014, respectively). ARD vs. control status was the only independent predictor of having any brain lesion. Specifically for deep white matter lesions, each increase in ECV independently predicted a higher number of lesions [odds ratio (95% confidence interval): 1.16 (1.01–1.33), p = 0.031] in ordered logistic regression. Penalized logistic regression selected only ARD vs. control status as the most important feature for predicting whether brain lesions were present on brain MRI (odds ratio: 5.46, marginal false discovery rate = 0.011). Conclusions: Subclinical brain involvement was highly prevalent in this cohort of ARD patients and was mostly independent of the severity of cardiac involvement. However, further research is required to determine the clinical relevance of these findings.

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Cardiac Tissue Characterization and Imaging in Autoimmune Rheumatic Diseases

Cited by 31 publications

References 77 publications

Myocardial tissue characterisation using echocardiographic deformation imaging

Myocardial tissue characterisation using echocardiographic deformation imaging

Silent Myocardial Perfusion Abnormalities Detected by Stress Cardiovascular Magnetic Resonance in Antiphospholipid Syndrome: A Case-Control Study

Combined Brain-Heart Magnetic Resonance Imaging in Autoimmune Rheumatic Disease Patients with Cardiac Symptoms: Hypothesis Generating Insights from a Cross-Sectional Study

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