Cardiovascular magnetic resonance imaging pattern at the time of diagnosis of treatment naïve patients with connective tissue diseases

Mavrogeni, Sophie; Markousis‐Mavrogenis, George; Κουτσογεωργοπούλου, Λουκία; Dimitroulas, Theodoros; Bratis, Konstantinos; Kitas, George D.; Sfikakis, Petros P.; Tektonidou, Maria G.; Karabela, Georgia; Stavropoulos, Efthymios; Katsifis, Gikas; Boki, Kyriaki; Kitsiou, Anastasia; Filaditaki, Vasiliki; Gialafos, Elias; Plastiras, Sotiris C.; Vartela, Vasiliki; Kolovou, Genovefa

doi:10.1016/j.ijcard.2017.01.104

Cited by 48 publications

(43 citation statements)

References 43 publications

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“…In acute myocarditis, T2w hyperintensity may be either focal, as in 30% of patients, or diffuse as in the remaining 70%, and may be the only marker of the disease. Tissue oedema may also be observed in other conditions, such as primary cardiomyopathies (CMP), storage diseases, pulmonary hypertension, cardiac transplant rejection and asymptomatic, treatment naïve patients with autoimmune rheumatic diseases . These findings emphasize the role of oedema as an early marker of pathophysiologic phenomena occurring in various myocardial diseases.…”

Section: Cmr Indices For Dmd Evaluationmentioning

confidence: 87%

Oedema‐fibrosis in Duchenne Muscular Dystrophy: Role of cardiovascular magnetic resonance imaging

Mavrogeni

Papavasiliou

Giannakopoulou

et al. 2017

Eur J Clin Investigation

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Duchenne muscular dystrophy (DMD) is an X-linked muscle disorder characterized by progressive, irreversible loss of cardiac and skeletal muscular function.Muscular enlargement in DMD is attributed to oedema, due to the increased cytoplasmic Na+ concentration. The aim of this review was to present the current experience and emphasize the role of cardiovascular magnetic resonance (CMR) in the diagnosis of this condition. DMD patients' survival depends on ventilatory assistance, as respiratory muscle dysfunction was the most common cause of death in the past. Currently, due to improved ventilatory assistance, cardiomyopathy has become the main cause of death, even though clinically overt heart failure may be absent. CMR is the technique of choice to assess the pathophysiologic phenomena taking place in DMD, such as myocardial oedema and subepicardial fibrosis. The classic index to assess oedema is the T2-weighted short-tau inversion recovery (T2w-STIR), as it suppresses the signal from flowing blood and resident fat and enhances sensitivity to tissue fluid. Furthermore, CMR is the most reliable technique to detect and quantify fibrosis in DMD. Recently, the new indices T2, T1 mapping (native and postcontrast) and the extracellular volume (ECV) allow a more accurate approach of myocardial oedema and fibrosis. To conclude, the assessment of cardiac oedema and subepicardial fibrosis in the inferolateral wall of the left heart ventricle are the most important early finding in DMD with preserved ventricular function, and CMR, using both the classic and the new indices, is the best technique to detect and monitor these lesions.

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Section: Cmr Indices For Dmd Evaluationmentioning

confidence: 87%

Oedema‐fibrosis in Duchenne Muscular Dystrophy: Role of cardiovascular magnetic resonance imaging

Mavrogeni

Papavasiliou

Giannakopoulou

et al. 2017

Eur J Clin Investigation

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“…2). More recently, these techniques have also been applied for detection of cardiac manifestation of connective tissue diseases 13 . Inflammatory heart disease typically demonstrates subepicardial LGE-positive lesions 14 .…”

Section: This Report Resumes Three Cases Of Churg-strauss Syndrome (Cmentioning

confidence: 99%

Churg-Strauss syndrome with cardiac involvement: case illustration and contribution of CMR in the diagnosis and clinical follow-up

d'Ersu

Ribi

Monney

et al. 2018

International Journal of Cardiology

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This report summarises three cases of Churg-Strauss syndrome (CSS) illustrating the diagnostic challenges associated with the cardiac manifestation of this disease. Here, we illustrate the role of cardiac magnetic resonance (CMR) for diagnosis and follow-up of CSS with a focus on new non-contrast T-weighted imaging sequences for quantification of myocardial scar tissue and quantitative T mapping techniques, which allow the detection of myocardial edema.

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“…Cardiovascular magnetic resonance (CMR) is a non-invasive imaging modality that provides detailed information regarding various cardiovascular pathologies without employing ionizing radiation. CMR can make up for many of the limitations of echocardiography and is considered the reference standard for quantitative evaluation of ventricular volumes, mass, function and cardiac tissue characterization [15]. We hypothesized that CMR would have incremental diagnostic/prognostic value in SSc patients presenting with acute onset of cardiac symptoms but having a normal echocardiogram.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular Magnetic Resonance Identifies High-Risk Systemic Sclerosis Patients with Normal Echocardiograms and Provides Incremental Prognostic Value

et al. 2019

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Background: Acute cardiac events are a significant contributor to mortality in systemic sclerosis (SSc). However, echocardiographic evaluation may be deceptively normal during an acute presentation. We hypothesized that in diffuse SSc patients presenting with acute cardiac events and a normal echocardiogram, cardiovascular magnetic resonance (CMR) would have incremental diagnostic/prognostic value. Methods. 50 consecutive diffuse SSc patients with normal echocardiograms were evaluated using a 1.5T system. A total of 27 (63%) had experienced an acute cardiac event three to tendays before CMR evaluation (rhythm disturbances, angina pectoris, shortness of breath). Left/right ventricular (LV/RV) volumes and ejection fractions (EF), as well as LV mass, the T2-signal ratio, early/late gadolinium enhancement (EGE/LGE), native/post-contrast T1-mapping, T2-mapping and extracellular volume fraction (ECV) were compared between the event and no-event groups. Results: No differences were identified in LV/RV volumes/EF/mass. In logistic regression analyses, independent predictors of belonging to the event group were EGE (odds ratio (95% CI): 1.55 (1.06-2.26), p = 0.024), LGE (1.81 (1.23-2.67), p = 0.003), T2 mapping (1.20 (1.06-1.36), p = 0.004) and native/post-contrast T1 mapping (1.17 (1.04-1.32), p = 0.007 and 0.86 (0.75-0.98), p = 0.025). At a median follow-up of~1.2 years, 42% vs. 11% of the event/no-event group respectively reached a combined endpoint of event occurrence/recurrence or cardiovascular mortality. Of the independent predictors resulting from logistic regression analyses, only LGE (hazard ratio (95% CI): 1.20 (1.11-1.30), p < 0.001), T2-mapping (1.07 (1.01-1.14), p = 0.025) and native T1-mapping (1.08 (1.01-1.15), p = 0.017) independently predicted the combined endpoint. Conclusions: A normal echocardiogram does not preclude myocardial lesions in diffuse SSc patients, which can be detected by CMR especially in symptomatic patients.

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Cardiovascular magnetic resonance imaging pattern at the time of diagnosis of treatment naïve patients with connective tissue diseases

Cited by 48 publications

References 43 publications

Oedema‐fibrosis in Duchenne Muscular Dystrophy: Role of cardiovascular magnetic resonance imaging

Oedema‐fibrosis in Duchenne Muscular Dystrophy: Role of cardiovascular magnetic resonance imaging

Churg-Strauss syndrome with cardiac involvement: case illustration and contribution of CMR in the diagnosis and clinical follow-up

Cardiovascular Magnetic Resonance Identifies High-Risk Systemic Sclerosis Patients with Normal Echocardiograms and Provides Incremental Prognostic Value

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