Cardiovascular magnetic resonance in autoimmune rheumatic diseases: a clinical consensus document by the European Association of Cardiovascular Imaging

Abstract

Autoimmune rheumatic diseases (ARDs) involve multiple organs including the heart and vasculature. Despite novel treatments, patients with ARDs still experience a reduced life expectancy, partly caused by the higher prevalence of cardiovascular disease (CVD). This includes CV inflammation, rhythm disturbances, perfusion abnormalities (ischaemia/infarction), dysregulation of vasoreactivity, myocardial fibrosis, coagulation abnormalities, pulmonary hypertension, valvular disease, and side-effects of immunomodulatory therapy. Currently, the evaluation of CV involvement in patients with ARDs is based on the assessment of cardiac symptoms, coupled with electrocardiography, blood testing, and echocardiography. However, CVD may not become overt until late in the course of the disease, thus potentially limiting the therapeutic window for intervention. More recently, cardiovascular magnetic resonance (CMR) has allowed for the early identification of pathophysiologic structural/functional alterations that take place before the onset of clinically overt CVD. CMR allows for detailed evaluation of biventricular function together with tissue characterization of vessels/myocardium in the same examination, yielding a reliable assessment of disease activity that might not be mirrored by blood biomarkers and other imaging modalities. Therefore, CMR provides diagnostic information that enables timely clinical decision-making and facilitates the tailoring of treatment to individual patients. Here we review the role of CMR in the early and accurate diagnosis of CVD in patients with ARDs compared with other non-invasive imaging modalities. Furthermore, we present a consensus-based decision algorithm for when a CMR study could be considered in patients with ARDs, together with a standardized study protocol. Lastly, we discuss the clinical implications of findings from a CMR examination.

Cardiac Magnetic Resonance in Rheumatology to Detect Cardiac Involvement Since Early and Pre-clinical Stages of the Autoimmune Diseases: A Narrative Review

“…Currently, it is in-press and European Association of Cardiovascular Imaging (EACVI) Position Paper, entitled Role of Cardiovascular Magnetic Resonance in Autoimmune Rheumatic Diseases, where Mavrogeni et al (268) review the promising role of CMR in the early and accurate diagnosis of the CV involvement in the AD, providing comprehensive CMR protocols and diagnostic algorithms for its use, highlighting its role to start the precise and effective specific therapeutic approach timely and not when conventional imaging modalities and the clinical manifestations show the involvement of the CV system; impacting the outcomes of these complex patients positively.…”

Cardiovascular Magnetic Resonance Demonstrates Myocardial Inflammation of Differing Etiologies and Acuities in Patients with Genetic and Inflammatory Myopathies

“…The MOCO T1 (pre- and post-contrast) maps were generated by the scanner and later used for calculating ECV maps. All patients provided a recent measurement of hematocrit to be used in calculating the subject-specific ECV [ 20 ].…”

Connective tissue disease‐associated pulmonary hypertension: A comprehensive review

“…Cardiac magnetic resonance (CMR) imaging has multiple advantages over echocardiography and its use for the assessment of PAH and RV dysfunction has increased over the years. In addition to its increased diagnostic accuracy for PH compared to echocardiography, it may be particularly useful in patients with CTD, who often have additional cardiac pathologies 103,104 . CMR allows for a more detailed evaluation of biventricular function, vessels, the myocardium, and the pericardium all in a single study and may additionally allow for the identification of early, subclinical disease 105,106 .…”