Cardiac magnetic resonance imaging for the detection of myocardial involvement in granulomatosis with polyangiitis
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ORIGINAL PAPER
Cardiac magnetic resonance imaging for the detection of myocardial involvement in granulomatosis with polyangiitis Alessandro Giollo1,2,4 · Raluca B. Dumitru1,2 · Peter P. Swoboda3 · Sven Plein1,3 · John P. Greenwood1,3 · Maya H. Buch2,5,6 · Jacqueline Andrews1 Received: 23 March 2020 / Accepted: 5 October 2020 © The Author(s) 2020
Abstract The prevalence of undiagnosed cardiac involvement in granulomatosis with polyangiitis (GPA) is unknown. In this prospective study we investigated the utility of cardiovascular magnetic resonance (CMR) to identify myocardial abnormalities in GPA and their correlation with disease phenotype. Twenty-six patients with GPA and no cardiovascular disease or diabetes mellitus underwent contrast-enhanced CMR, including late gadolinium-enhancement (LGE), T1-mapping for native T1 and extra-cellular volume (ECV) quantification for assessment of myocardial fibrosis, cine imaging and tissue tagging for assessment of left ventricular (LV) function. Twenty-five healthy volunteers (HV) with comparable age, sex, BMI and arterial blood pressure served as controls. Patients with GPA had similar cardiovascular risk profile to HV. A focal, non-ischaemic LGE pattern of fibrosis was detected in 24% of patients and no controls (p = 0.010). Patients with myocardial LGE were less frequently PR3 ANCA (7% vs 93%, p = 0.007), and had involvement of the lower respiratory tract and skin. LGE scar mass was higher in patients presenting with renal involvement. Native T1 and ECV were higher in patients with GPA than HV; ECV was higher in those with relapsing disease, and native T1 was inversely associated with PR3 ANCA (β = − 0.664, p = 0.001). Peak systolic strain was slightly reduced in GPA compared to controls; LV ejection function was inversely correlated with disease duration (β = − 0.454, p = 0.026). Patients with GPA have significant myocardial abnormalities on CMR. ANCA, systemic involvement and disease severity were associated with myocardial fibrosis. CMR could be a useful tool for risk stratification of myocardial involvement in GPA. Keywords Vasculitis · Granulomatosis with polyangiitis · Cardiovascular disease · CMR · ANCA · Myocardial fibrosis · LGE
Introduction Alessandro Giollo and Raluca Dumitru contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10554-020-02066-2) contains supplementary material, which is available to authorized users. * Alessandro Giollo [email protected] 1
NIHR Leeds Biomedical Research Centre and Clinical Research Facility, Leeds Teaching Hospitals NHS Trust, Leeds, UK
2
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
3
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
Granulomatosis with polyangiitis (GPA), a systemic inflammatory disease, is an ANCA-associated small-vessel vasculitides (AAV) [1] with significant morbidity and mortality [2, 3]. Recent epidemiological studies
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