Myocardial Involvement in Rheumatic Disorders
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IMAGING IN HEART FAILURE (J SCHULZ-MENGER, SECTION EDITOR)
Myocardial Involvement in Rheumatic Disorders George Markousis-Mavrogenis 1 & Alessia Pepe 2 & Luna Gargani 3 & Urania Kariki 1 & Maria Bonou 4 & Loukia Koutsogeorgopoulou 5 & Dionysia Manolopoulou 1 & Maria G. Tektonidou 6 & Vasiliki Vartela 1 & Genovefa Kolovou 1 & Sophie I. Mavrogeni 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Autoimmune rheumatic diseases (ARDs) affect 8% of the population and approximately 78% of patients are women. Myocardial disease in ARDs is the endpoint of various pathophysiologic mechanisms including atherosclerosis, valvular disease, systemic, myocardial, and/or vascular inflammation, as well as myocardial ischemia and replacement/diffuse fibrosis. Recent Findings The increased risk of CVD in ARDs leads to excess comorbidity not fully explained by traditional cardiovascular risk factors. It seems that the chronic inflammatory status typically seen in ARDs, promotes both the development of myocardial inflammation/fibrosis and the acceleration of atherosclerosis. Summary CMR (cardio-vascular magnetic resonance) is the ideal imaging modality for the evaluation of cardiac involvement in patients with ARDs, as it can simultaneously assess cardiac function and characterize myocardial tissues with regard to oedema and fibrosis. Due to its high spatial resolution, CMR is capable of identifying various disease entities such as myocardial oedema /inflammation, subendocardial vasculitis and myocardial fibrosis, that are often missed by other imaging modalities, notably at an early stage of development. Although generally accepted guidelines about the application of CMR in ARDs have not yet been formulated, according to our experience and the available published literature, we recommend CMR in ARD patientS with newonset heart failure (HF), arrhythmia, for treatment evaluation/change or if there is any mismatch between patient symptoms and routine non-invasive evaluation. Keywords Echocardiography . Cardiovascular magnetic resonance . Nuclear imaging . Cardiovascular computed tomography . Myocardial perfusion-fibrosis . Coronary artery disease . Vasculitis . Rheumatic cardiovascular disease . Myocarditis
Introduction
This article is part of Topical Collection on Imaging in Heart Failure * Sophie I. Mavrogeni [email protected] 1
Onassis Cardiac Surgery Center, 50 Esperou Street, 175-61 P. Faliro, Athens, Greece
2
Magnetic Resonance Imaging Unit, Fondazione G. Monasterio C.N.R, Pisa, Italy
3
Institute of Clinical Physiology, National Research Council, Pisa, Italy
4
Dpt of Cardiology, Laikon Hospital, Athens, Greece
5
Dpt Pathophysiology, Laikon Hospital, Athens, Greece
6
Joint Rheumatology, Laikon Hospital, National Kapodistrian University of Athens, Medical School, Athens, Greece
Autoimmune rheumatic diseases (ARDs) affect 8% of the population and approximately 78% of patients are women [1]. Myocardial disease in ARDs is the endpoint of various pathophysiologic mechanisms s
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