Cardiovascular magnetic resonance in rheumatology: Current status and recommendations for use

Abstract

Targeted therapies in connective tissue diseases (CTDs) have led to improvements of disease-associated outcomes, but life expectancy remains lower compared to general population due to emerging co-morbidities, particularly due to excess cardiovascular risk. Cardiovascular magnetic resonance (CMR) is a noninvasive imaging technique which can provide detailed information about multiple cardiovascular pathologies without using ionizing radiation. CMR is considered the reference standard for quantitative evaluation of left and right ventricular volumes, mass and function, cardiac tissue characterization and assessment of thoracic vessels; it may also be used for the quantitative assessment of myocardial blood flow with high spatial resolution and for the evaluation of the proximal coronary arteries. These applications are of particular interest in CTDs, because of the potential of serious and variable involvement of the cardiovascular system during their course. The International Consensus Group on CMR in Rheumatology was formed in January 2012 aiming to achieve consensus among CMR and rheumatology experts in developing initial recommendations on the current state-of-the-art use of CMR in CTDs. The present report outlines the recommendations of the participating CMR and rheumatology experts with regards to: (a) indications for use of CMR in rheumatoid arthritis, the spondyloarthropathies, systemic lupus erythematosus, vasculitis of small, medium and large vessels, myositis, sarcoidosis (SRC), and scleroderma (SSc); (b) CMR protocols, terminology for reporting CMR and diagnostic CMR criteria for assessment and quantification of cardiovascular involvement in CTDs; and (c) a research agenda for the further development of this evolving field.

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

“…Cardiovascular disease is the main cause of increased mortality/morbidity in autoimmune rheumatic diseases, due to its silent presentation and the limitations of the currently used techniques that cannot perform tissue characterization [82]. Occult cardiovascular disease is common in rheumatoid arthritis, and up to 39% of rheumatoid arthritis patients have been reported to show focal LGE patterns, probably related to earlier myocarditis [83].…”

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

“…However, in CTDs, heart failure with preserved ejection fraction (LVPEF) is more common than overt left ventricular failure [41]. In a study of sarcoid patients, it was documented that patients with LGE were at significant risk for VT/SCD, even if they had preserved left ventricular ejection fraction.…”

“…In a study of sarcoid patients, it was documented that patients with LGE were at significant risk for VT/SCD, even if they had preserved left ventricular ejection fraction. In these patients, increased LGE burden and right ventricular dysfunction identified those at highest risk of death/VT [41]. Additionally, RV involvement in CTDs facilitate the development of VT/SCD [42].…”

Critical finger ischemia and myocardial fibrosis development after sudden interruption of sildenafil treatment in a systemic sclerosis patient

“…In our case, cardiac MRI was useful in detecting early myocardial involvement. MRI was previously suggested as a screening tool to analyze non-symptomatic scleroderma patients and identify subclinical involvement (7)(8)(9). According to the previously proposed hypothesis of myocardial RP (10), we believe that the development of myocardial fibrosis could have been the effect of a sufferance of epicardial coronaries due to a prolonged vasospasm (11).…”