Echocardiography in Autoimmune Rheumatic Diseases for Diagnosis and Prognosis of Cardiovascular Complications

Makavos, George; Varoudi, Maria; Papangelopoulou, K; Kapniari, E; Plotas, Panagiotis; Ikonomidis, Ignatios; Papadavid, Evangelia

doi:10.3390/medicina56090445

Cited by 7 publications

(8 citation statements)

References 87 publications

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“…Several studies have demonstrated the effectiveness of novel echocardiography techniques (Tissue Doppler Imaging), especially global longitudinal strain through speckle monitoring, in assessing subclinical cardiac involvement and left ventricular diastolic dysfunction [ 5 ]. ECHO is a primary tool for detecting CV involvement, and it also assists in monitoring the therapeutic effects and disease progression [ 1 ]. A noninvasive method for detecting ATS plaques in the carotid artery is carotid ultrasound investigation [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

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Cardiovascular Risk Prediction Parameters for Better Management in Rheumatic Diseases

et al. 2022

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The early detection of cardiovascular disease (CVD) serves as a key element in preventive cardiology. The risk of developing CVD in patients with rheumatic disease is higher than that of the general population. Thus, the objective of this narrative review was to assess and describe updated risk-prediction parameters for CVD in patients suffering from rheumatic diseases, and, additionally, to evaluate therapeutic and risk management possibilities. The processes of recognizing CVD risk factors in rheumatic diseases, establishing diagnoses, and discovering CV risk assessments are currently displeasing in clinical practice; they have a limited clinical impact. A large number of references were found while screening PUBMED, Scopus, and Google scholar databases; the 47 most relevant references were utilized to build up this study. The selection was limited to English language full text articles, RCTs, and reviews published between 2011 and 2021. Multiple imaging techniques, such as ECG, ultrasound, and cIMT, as well as biomarkers like osteoprotegerin cytokine receptor and angiopoietin-2, can be beneficial in both CV risk prediction and in early subclinical diagnosis. Physical exercise is an essential non-pharmacological intervention that can maintain the health of the cardiovascular system and, additionally, influence the underlying disease. Lipid-lowering drugs (methotrexate from the non-biologic DMARDs family as well as biologic DMARDs such as anti-TNF) were all associated with a lower CV risk; however, anti-TNF medication can decrease cardiac compliance and promote heart failure in patients with previously diagnosed chronic HF. Although they achieved success rates in reducing inflammation, glucocorticoids, NSAIDs, and COX-2 inhibitors were correlated with an increased risk of CVD. When taking all of the aforementioned points into consideration, there appears to be a dire need to establish and implement CVD risk stratification models in rheumatic patients.

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Section: Discussionmentioning

confidence: 99%

“…Autoimmune-inflammatory rheumatic diseases (ARDs) are a group of systemic immune-mediated disorders with the potential to target various joints, bones, and connective tissues [ 1 ]. They are also correlated with a higher risk of developing cardiovascular diseases (CVD) [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular Risk Prediction Parameters for Better Management in Rheumatic Diseases

et al. 2022

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“…In addition to assessing cardiovascular risk, CACS calculation also makes it possible to select more precisely those patients who need to be investigated with stress tests for silent myocardial ischemia [ 2 , 15 ]. We chose to use trans-thoracic echocardiography combined with ECG-coupled stress echocardiography because these imaging examinations are non-invasive and enable the researcher to visualize cardiac pathologies other than coronary artery disease, as seen in autoimmune diseases [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Is the Calcium Score Useful for Rheumatoid Arthritis Patients at Low or Intermediate Cardiovascular Risk?

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et al. 2022

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Cardiovascular disease, particularly myocardial infarction, is the leading cause of death of rheumatoid arthritis (RA) patients. The usefulness of the coronary artery calcification score (CACS), determined using cardiac computed-tomography (CT)-scan images, was assessed as a part of a cardiovascular work-up of RA patients at low or intermediate cardiovascular disease risk. This descriptive, cross-sectional, single-center study was conducted on patients with stable RA or that which is in remission. Each patient’s work-up included a collection of cardiovascular risk factors, laboratory analyses, an electrocardiogram, a supra-aortic trunks (SATs) echo-Doppler test and a cardiac CT scan. The primary endpoint was to determine the frequency of patients with a CACS > 100, indicating notable atherosclerosis. Fifty patients were analyzed: mean ± standard deviation age was 53.7 ± 7.5 years, 82% women. The CACS exceeded 100 in 12 (24%) patients (11 were at intermediate risk) and 2 of them underwent angioplasty for silent myocardial ischemia. Cardiovascular risk was reclassified from intermediate to high for 5 patients. Age according to sex and smoking status were significantly associated with that increase; no association was found with RA characteristics or treatments.

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“…Interestingly, Ajeganova et al showed in a 10-year case-control-study, that SLE patients had a three- to four-fold higher risk of CV events and death, compared with persons who do not have SLE but with a similar pattern of traditional CVD risk factors and subclinical atherosclerosis measured with carotid intima-media thickness and presence of carotid plaque ( 36 ). A significantly improved prediction of the adverse outcome could be accomplished with the combination of cIMT measures with the Systemic Lupus International Collaborating Clinics (SLICC) Damage Index and coexistence of SLE-antiphospholipid syndrome (SLE-APS) ( 37 ). These findings highlight the necessity of a comprehensive approach to risk stratification and management.…”

Section: Cardiovascular Imaging: Detecting Subtle Changesmentioning

confidence: 99%

“…Echocardiography has found its way into routine preventative care in patients with autoimmune and rheumatological diseases, as the presence of cardiac abnormalities, such as heart muscle damage, pericardial involvement and valvular heart disease are relatively common. However, early structural, and functional changes are often subtle and not easy to detect ( 37 ). Therefore, conventional echocardiographic parameters may often be not sufficient to find these early abnormalities of cardiac dysfunction especially if the global ventricular function is normal.…”

Section: Cardiovascular Imaging: Detecting Subtle Changesmentioning

confidence: 99%

Novel Surrogate Markers of Cardiovascular Risk in the Setting of Autoimmune Rheumatic Diseases: Current Data and Implications for the Future

et al. 2022

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Patients suffering from rheumatologic diseases are known to have an increased risk for cardiovascular disease (CVD). Although the pathological mechanisms behind this excess risk have been increasingly better understood, there still seems to be a general lack of consensus in early detection and treatment of endothelial dysfunction and CVD risk in patients suffering from rheumatologic diseases and in particular in those who haven't yet shown symptoms of CVD. Traditional CVD prediction scores, such as Systematic Coronary Risk Evaluation (SCORE), Framingham, or PROCAM Score have been proposed as valid assessment tools of CVD risk in the general population. However, these risk calculators developed for the general population do not factor in the effect of the inflammatory burden, as well as other factors that can increase CVD risk in patients with rheumatic diseases, such as glucocorticoid therapy, abnormal lipoprotein function, endothelial dysfunction or accelerated atherosclerosis. Thus, their sole use could lead to underestimation of CVD risk in patients with rheumatic diseases. Therefore, there is a need for new biomarkers which will allow a valid and early assessment of CVD risk. In recent years, different research groups, including ours, have examined the value of different CVD risk factors such as carotid sonography, carotid-femoral pulse wave velocity, flow-mediated arterial dilation and others in the assessment of CVD risk. Moreover, various novel CVD laboratory markers have been examined in the setting of autoimmune diseases, such as Paraoxonase activity, Endocan and Osteoprotegerin. Dyslipidemia in rheumatoid arthritis (RA) is for instance better quantified by lipoproteins and apolipoproteins than by cholesterol levels; screening as well as pre-emptive carotid sonography hold promise to identify patients earlier, when prophylaxis is more likely to be effective. The early detection of subtle changes indicating CVD in asymptomatic patients has been facilitated through improved imaging methods; the inclusion of artificial intelligence (AI) shows promising results in more recent studies. Even though the pathophysiology of coronary artery disease in patients with autoimmune rheumatic diseases has been examined in multiple studies, as we continuously gain an increased understanding of this comorbidity, particularly in subclinical cases we still seem to fail in the stratification of who really is at risk—and who is not. A the time being, a multipronged and personalized approach of screening patients for traditional CVD risk factors, integrating modern imaging and further CV diagnostic tools and optimizing treatment seems to be a solid approach. There is promising research on novel biomarkers, likewise, methods using artificial intelligence in imaging provide encouraging data indicating possibilities of risk stratification that might become gold standard in the near future. The present review concentrates on showcasing the newest findings concerning CVD risk in patients with rheumatologic diseases and aims to evaluate screening methods in order to optimize CVD risk evaluation and thus avoiding underdiagnosis and undertreatment, as well as highlighting which patient groups are most at risk.

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Echocardiography in Autoimmune Rheumatic Diseases for Diagnosis and Prognosis of Cardiovascular Complications

Cited by 7 publications

References 87 publications

Cardiovascular Risk Prediction Parameters for Better Management in Rheumatic Diseases

Cardiovascular Risk Prediction Parameters for Better Management in Rheumatic Diseases

Is the Calcium Score Useful for Rheumatoid Arthritis Patients at Low or Intermediate Cardiovascular Risk?

Novel Surrogate Markers of Cardiovascular Risk in the Setting of Autoimmune Rheumatic Diseases: Current Data and Implications for the Future

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