Combined Brain-Heart Magnetic Resonance Imaging in Autoimmune Rheumatic Disease Patients with Cardiac Symptoms: Hypothesis Generating Insights from a Cross-Sectional Study

Abstract

Background: Autoimmune rheumatic diseases (ARDs) may affect both the heart and the brain. However, little is known about the interaction between these organs in ARD patients. We asked whether brain lesions are more frequent in ARD patients with cardiac symptoms compared with non-ARD patients with cardiovascular disease (CVD). Methods: 57 ARD patients with mean age of 48 ± 13 years presenting with shortness of breath, chest pain, and/or palpitations, and 30 age-matched disease-controls with non-autoimmune CVD, were evaluated using combined brain–heart magnetic resonance imaging (MRI) in a 1.5T system. Results: 52 (91%) ARD patients and 16 (53%) controls had white matter hyperintensities (p < 0.001) in at least one brain area (subcortical/deep/periventricular white matter, basal ganglia, pons, brainstem, or mesial temporal lobe). Only the frequency and number of subcortical and deep white matter lesions were significantly greater in ARD patients (p < 0.001 and 0.014, respectively). ARD vs. control status was the only independent predictor of having any brain lesion. Specifically for deep white matter lesions, each increase in ECV independently predicted a higher number of lesions [odds ratio (95% confidence interval): 1.16 (1.01–1.33), p = 0.031] in ordered logistic regression. Penalized logistic regression selected only ARD vs. control status as the most important feature for predicting whether brain lesions were present on brain MRI (odds ratio: 5.46, marginal false discovery rate = 0.011). Conclusions: Subclinical brain involvement was highly prevalent in this cohort of ARD patients and was mostly independent of the severity of cardiac involvement. However, further research is required to determine the clinical relevance of these findings.

The Emerging Role of Combined Brain/Heart Magnetic Resonance Imaging for the Evaluation of Brain/Heart Interaction in Heart Failure

“…At the moment, there is no data supporting a combined brain/heart evaluation in HF, except one study in autoimmune rheumatic diseases with cardiac symptoms, published by our group [ 56 ]. However, it has been documented that HF patients exhibit CD of attention and memory, and medial temporal lobe atrophy (MTA) seems to be responsible [ 57 ].…”

Organ Manifestation and Systematic Organ Screening at the Onset of Inflammatory Rheumatic Diseases

“…Further, there is evidence that cerebral MRI can detect vascular and inflammatory lesions in IRD [ 59 , 60 ]. Markousis-Mavrogenis et al observed that subclinical CNS involvement was frequent in IRD patients with cardiac symptoms and cardiac involvement [ 61 ]. Consequently, MRT is the optimal technique for the simultaneous detection of cerebral and cardiac inflammatory involvement in IRD [ 62 ].…”

Cardiac Remodeling in Hypertension: Clinical Impact on Brain, Heart, and Kidney Function

“…2). T2-mapping is performed on 3 corresponding LV short-axis slices using a black-blood prepared, navigator-gated, free-breathing hybrid gradient (echo planar imaging) and spinecho multiecho sequence [67]. Finally, T2 mapping can identify a specific group of hypertensions with myocardial edema [40].…”

“…A standard MRI protocol for brain evaluation should include the following measurements [67]: a) Spin-echo T1-and T2-weighted imaging where only fat is bright, while in T2 imaging both fat and water are bright. FLAIR imaging is also similar to T2 and can be used to identify subtle oedema after a stroke (▶Fig.…”