Cardiovascular Magnetic Resonance Imaging clarifies cardiac pathophysiology in early, asymptomatic diffuse systemic sclerosis

Mavrogeni, Sophie; Bratis, Konstantinos; Karabela, Georgia; Spiliotis, George; Wijk, Kees van; Hautemann, David; Reiber, J. H. C.; Κουτσογεωργοπούλου, Λουκία; Markousis‐Mavrogenis, George; Kolovou, Genovefa; Stavropoulos, Efthymios

doi:10.2174/1871528114666150916112551

Cited by 61 publications

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“…However, this is not unusual because lack of such correlation was also identified in both infective [23] and autoimmune myocarditis [8, 13, 24]. This lack of correlation further emphasizes the role of CMR as a powerful diagnostic tool that can provide direct tissue characterization beyond clinical and laboratory findings and potentially modify both rheumatic and cardiac treatment.…”

Section: Discussionmentioning

confidence: 98%

“…Indeed, in SSc, fibrosis may not be used as an independent criterion of myocarditis, since it represents the result of both myocarditis and fibrotic disease independent of inflammatory processes, typical of SSc. On the other hand, the diagnosis of asymptomatic myocarditis in SSc is extremely significant, because it demands prompt rheumatic treatment to avoid future irreversible cardiac lesions [7]; furthermore, although it is easy to diagnose the presence of clinically overt myocarditis, which usually presents with concurrent myositis in SSc [7], it remains rather difficult to achieve this target in asymptomatic cases [8, 13, 18]. The presence of 3 positive CMR indices in all our patients emphasizes the clinical role of Lake Louise criteria in the early detection of asymptomatic myocarditis in SSc.…”

Section: Discussionmentioning

confidence: 99%

“…Cardiovascular Magnetic Resonance (CMR), a non-invasive, non-radiating, operator independent technique, has been successfully used for the evaluation of myocardial fibrosis in SSc [8, 9]. The ability to perform tissue characterisation makes CMR an excellent diagnostic tool to detect myocarditis either due to infective [10] or connective tissue diseases, including SSc [11–15].…”

Section: Introductionmentioning

confidence: 99%

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Silent myocarditis in systemic sclerosis detected by cardiovascular magnetic resonance using Lake Louise criteria

Mavrogeni

Κουτσογεωργοπούλου

Karabela

et al. 2017

BMC Cardiovasc Disord

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BackgroundSystemic sclerosis (SSc) is an autoimmune disease characterized by microvascular abnormalities, inflammation and fibrosis. We hypothesized that myocarditis may be diagnosed in asymptomatic SSc, undergoing routine cardio-vascular magnetic resonance (CMR) for fibrosis assessment, using the Lake Louise criteria: T2 ratio, early (EGE) and late gadolinium enhanced (LGE) images.MethodsEighty-two asymptomatic SSc, diagnosed according to American College of Rheumatology criteria, aged 43 ± 5 yrs., 62 with diffuse (dSSc) and 20 with localized (lSSc) systemic sclerosis were evaluated by CMR, performed at 1.5 T scanner, according to Lake Louise criteria.ResultsCMR documented normal biventricular function in all SSc. However, 7/62 (11.2%) with dSSc and 2/20 (10%) with lSSc, had CMR signs of myocarditis according to Lake Louise criteria, without any clinical cardiac symptom. In these 9 patients, T2 ratio, EGE ratio and LGE (positive in all 9 SSc) were 2.8 ± 0.5%, 8 ± 3% and 5 ± 3% of LV mass, respectively. No correlation between CMR and blood inflammatory indices (C-reactive protein and erythrocyte sedimentation rate), cardiac troponin T, disease characteristics or type of SSc was identified. A repeat CMR at 6 months, after treatment with prednisone and azathioprine, showed normalisation of the acute inflammation CMR indices.ConclusionsSilent myocarditis may be diagnosed using the Lake Louise paper criteria in SSc patients without cardiac symptoms, has no correlation with blood inflammatory indices, cardiac troponin or disease characteristics. CMR is a promising tool to diagnose silent myocarditis in SSc and monitor the response to immunosuppressive treatment.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Silent myocarditis in systemic sclerosis detected by cardiovascular magnetic resonance using Lake Louise criteria

Mavrogeni

Κουτσογεωργοπούλου

Karabela

et al. 2017

BMC Cardiovasc Disord

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“…Low-grade inflammation, perfusion defects, and diffuse myocardial fibrosis have already been well described as co-existing factors [86]. They can be detected by T2-STIR and LGE imaging.…”

Section: Internal Medicine Diseases Where the Value Of T1 And T2 Mappmentioning

confidence: 99%

T1 and T2 Mapping in Cardiology: “Mapping the Obscure Object of Desire”

Mavrogeni

Apostolou²,

Argyriou³

et al. 2017

Cardiology

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The increasing use of cardiovascular magnetic resonance (CMR) is based on its capability to perform biventricular function assessment and tissue characterization without radiation and with high reproducibility. The use of late gadolinium enhancement (LGE) gave the potential of non-invasive biopsy for fibrosis quantification. However, LGE is unable to detect diffuse myocardial disease. Native T1 mapping and extracellular volume fraction (ECV) provide knowledge about pathologies affecting both the myocardium and interstitium that is otherwise difficult to identify. Changes of myocardial native T1 reflect cardiac diseases (acute coronary syndromes, infarction, myocarditis, and diffuse fibrosis, all with high T1) and systemic diseases such as cardiac amyloid (high T1), Anderson-Fabry disease (low T1), and siderosis (low T1). The ECV, an index generated by native and post-contrast T1 mapping, measures the cellular and extracellular interstitial matrix (ECM) compartments. This myocyte-ECM dichotomy has important implications for identifying specific therapeutic targets of great value for heart failure treatment. On the other hand, T2 mapping is superior compared with myocardial T1 and ECM for assessing the activity of myocarditis in recent-onset heart failure. Although these indices can significantly affect the clinical decision making, multicentre studies and a community-wide approach (including MRI vendors, funding, software, contrast agent manufacturers, and clinicians) are still missing.

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“…VT and SCD can be also assessed during polymyostis (PM) and dermato-myositis (DM), although their incidence has been poorly defined [9][10][11][12][13]. VT in CTDs can be due to various pathologies including myocardial inflammation, myocardial ischemia due to obstructive disease of epicardial coronary arteries, coronary artery spasm, microvascular disease and myocardial scar, either of ischemic or non-ischemic origin.…”

Section: Introductionmentioning

confidence: 99%

Ventricular Tachycardia and Sudden Cardiac Death in Connective Tissue Diseases: Can Cardiovascular Magnetic Resonance Play a Role?

Mavrogeni¹,

Poulos²

2016

Rheumatology (Sunnyvale)

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Cardiovascular Magnetic Resonance Imaging clarifies cardiac pathophysiology in early, asymptomatic diffuse systemic sclerosis

Abstract: CMR may reveal severe cardiac involvement in early, asymptomatic diffuse SSc with normal routine cardiac evaluation, presenting either as myocardial inflammation or as severe reduction of MPRI and diffuse fibrosis with further deterioration in the long term follow up.

Cited by 61 publications

References 0 publications

Silent myocarditis in systemic sclerosis detected by cardiovascular magnetic resonance using Lake Louise criteria

Silent myocarditis in systemic sclerosis detected by cardiovascular magnetic resonance using Lake Louise criteria

T1 and T2 Mapping in Cardiology: “Mapping the Obscure Object of Desire”

Ventricular Tachycardia and Sudden Cardiac Death in Connective Tissue Diseases: Can Cardiovascular Magnetic Resonance Play a Role?

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