Cardiovascular Magnetic Resonance Detects Inflammatory Cardiomyopathy in Symptomatic Patients with Inflammatory Joint Diseases and a Normal Routine Workup

Abstract

Background. Patients with inflammatory joint diseases (IJD) are more likely to develop cardiovascular disease compared with the general population. We hypothesized that cardiovascular magnetic resonance (CMR) could identify cardiac abnormalities in patients with IJD and atypical symptoms unexplained by routine clinical evaluation. Patients-Methods. A total of 51 consecutive patients with IJD (32 with rheumatoid arthritis, 10 with ankylosing spondylitis, and 9 with psoriatic arthritis) and normal clinical, electrocardiographic and echocardiographic workups, were referred for CMR evaluation due to atypical chest pain, shortness of breath, and/or palpitations. Their CMR findings were compared with those of 40 non-IJD controls who were referred for the same reason. All participants were examined using either a 1.5 T or 3.0 T CMR system. For T1/T2 mapping, comparisons were performed separately for each field strength. Results. Biventricular systolic function was similar between groups. In total, 25 (49%) patients with IJD vs. 0 (0%) controls had replacement-type myocardial fibrosis (p < 0.001). The T2 signal ratio, early/late gadolinium enhancement, and extracellular volume fraction were significantly higher in the IJD group. Native T1 mapping was significantly higher in patients with IJD independent of the MRI field strength (p < 0.001 for both). T2 mapping was significantly higher in patients with IJD compared with controls only in those examined using a 1.5 T MR system—52.0 (50.0, 55.0) vs. 37.0 (33.5, 39.5), p < 0.001. Conclusions. In patients with IJD and a mismatch between cardiac symptoms and routine non-invasive evaluation, CMR uniquely identified a significant proportion of patients with myocardial inflammation. A CMR examination should be considered in patients with IJD in similar clinical settings.

Metabolic Syndrome and its Outcomes in Rheumatoid Arthritis: A Review

“…The latter have evidence of subclinical atherosclerosis as a result of increased carotid artery intima-media Article thickness (cIMT) and characteristic findings in cardiac MRI. [17][18][19] Met-S is higher in longstanding RA, individuals who are older, smokers, males, and post-menopausal females, and those with higher Disease Activity Score-28 (DAS-28) scores. 20,21 Males with RA and Met-S had higher individual components of the Met-S than females.…”

The Changing Complementary Role of Multimodality Imaging in Clinical Cardiology

“…Myocardial and pericardial disorders encompass hypertrophic, dilated, arrhythmogenic, infiltratory, restrictive, inflammatory and other diseases of different aetiologies. Multimodality cardiac imaging techniques are extremely helpful in the definition of diagnosis, the assessment of prognosis and for monitoring the evolving natural history of these disorders through the planning of adequate follow-ups and treatments [ 4 , 5 , 6 , 7 , 8 , 9 ]. Transthoracic echocardiography should be the first-line imaging modality, due to its availability and repeatability.…”

“…Transthoracic echocardiography should be the first-line imaging modality, due to its availability and repeatability. An important complementary role must be attributed to cardiovascular magnetic resonance (CMR), computed tomography and nuclear imaging, which are able to provide different types of accurate morphological and functional information, as well as extensive tissue characterization [ 4 , 5 , 6 , 7 , 8 , 9 ]. All this imaging information should be selectively incorporated into clinical decision making processes at the individual level, also taking into account the outstanding help clinical practice guidelines offer to clinicians [ 4 , 5 , 6 , 7 , 8 , 9 ].…”

“…An important complementary role must be attributed to cardiovascular magnetic resonance (CMR), computed tomography and nuclear imaging, which are able to provide different types of accurate morphological and functional information, as well as extensive tissue characterization [ 4 , 5 , 6 , 7 , 8 , 9 ]. All this imaging information should be selectively incorporated into clinical decision making processes at the individual level, also taking into account the outstanding help clinical practice guidelines offer to clinicians [ 4 , 5 , 6 , 7 , 8 , 9 ]. Multimodality imaging is a comprehensive strategy for the investigation of left ventricular hypertrophy (LVH), providing morphologic, functional and often clinical information to clinicians [ 5 ].…”

“…Furthermore, it is essential to uncover the specific cause of hypertrophic phenotypes, such as Fabry disease and cardiac amyloidosis, which can benefit from specific treatments [ 5 ]. In patients with inflammatory joint diseases and a mismatch between cardiac symptoms and routine noninvasive evaluations, CMR can uniquely identify a significant proportion of patients with myocardial inflammation [ 6 ]. The CMR-based assessment of the left atrial strain and left atrial strain rate could allow for a noninvasive diagnosis and the categorization of cardiac amyloidosis and its distinct differentiation from other hypertrophic phenotypes [ 7 ].…”