Silent Myocardial Perfusion Abnormalities Detected by Stress Cardiovascular Magnetic Resonance in Antiphospholipid Syndrome: A Case-Control Study

Abstract

Objective: To examine the prevalence of silent myocardial ischemia and fibrosis in antiphospholipid syndrome (APS), using stress cardiovascular magnetic resonance (CMR). Methods: Forty-four consecutive APS patients without prior cardiac disease (22 primary APS, 22 systemic lupus erythematosus (SLE)/APS, mean age 44 (12.9) years, 64% women) and 44 age/gender-matched controls were evaluated using CMR at 1.5 T. Steady-state free precession imaging for function assessment and adenosine stress-CMR for perfusion-fibrosis evaluation were employed. The myocardial perfusion reserve index (MPRI), and myocardial fibrosis expressed as late gadolinium enhancement (LGE), were evaluated. Coronary angiography was indicated in patients with LGE. Associations with APS characteristics, classic cardiovascular disease (CVD) risk factors, high-sensitivity CRP (hs-CRP) and high-sensitivity Troponin (hs-TnT) levels were tested. All patients were followed up for 12 months. Results: Median MPRI was significantly lower in APS patients versus controls [1.5 (0.9–1.9) vs. 2.7 (2.2–3.2), p < 0.001], independently of any LGE presence. LGE was detected in 16 (36.3%) patients versus none of controls (p < 0.001); 12/16 were subsequently examined with coronary angiography and only two of them had coronary artery lesions. In multivariable analysis, none of the APS-related and classic CVD risk factors, or hs-CRP and hs-TnT covariates, were significant predictors of abnormal MPRI or LGE. At the twelve month follow-up, three (6.8%) patients experienced coronary artery disease, notably those with the lowest MPRI values. Conclusions: Abnormal MPRI and LGE are common in asymptomatic APS patients, independently so of any APS-related and classic CVD risk factors, or coronary angiography findings in cases with LGE. Stress-CMR is a valuable tool to detect silent myocardial ischemia and fibrosis in APS.

Cardiovascular Magnetic Resonance Detects Inflammatory Cardiomyopathy in Symptomatic Patients with Inflammatory Joint Diseases and a Normal Routine Workup

“…Lastly, another point that merits discussion is the significantly lower LV mass that was identified in patients with IJD when compared with controls in our study. Such findings have also been reported in the past by our group in patients with antiphospholipid syndrome and systemic sclerosis with concomitant cardiac involvement [ 19 , 32 ], as well as in patients with RA by other researchers [ 33 ]. However, other studies have not been able to reproduce this finding [ 12 ].…”

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

“…As such, this demonstrates the need for a combined brain and heart MRI examination in ARD patients with cardiac symptoms, seeing as disease progression may evolve differently in the two organs. Notably, our group has previously reported that CMR findings are independent of C-reactive protein levels in ARD patients [47,51,52], often rendering biomarker-based pre-selection of patients for CMR examinations problematic. This would explain the current findings and suggests that such inflammatory biomarkers might have greater utility in evaluating brain involvement than cardiac involvement, although this needs to be corroborated by future independent studies.…”

Contemporary Role of Cardiac Magnetic Resonance in the Management of Patients with Suspected or Known Coronary Artery Disease

“…In patients with chronic LV dysfunction due to CAD, delayed enhancement CMR was found to provide the highest sensitivity and negative predicting value for predicting improved segmental LV contractile function after revascularization, whereas low dose dobutamine CMR provides the best specificity and positive predicting value [ 29 ]. Stress CMR has been studied for the detection of silent ischemia in patients with antiphospholipid syndrome [ 30 ]. In another study which enrolled children with Kawasaki disease and CAD, stress CMR was found to have 100% positive agreement and >90% negative and overall agreement with moderate to severe coronary artery stenoses as depicted by coronary artery angiography [ 31 ].…”