Cardiovascular magnetic resonance in autoimmune rheumatic diseases: a clinical consensus document by the European Association of Cardiovascular Imaging.
Sophie I MavrogeniAlessia PepeRobin NijveldtNtobeko A B NtusiLilia M Sierra-GalanK BratisJanet WeiMonica MukherjeeGeorge Markousis-MavrogenisLuna GarganiLeyla Elif SadeNina Ajmone MarsanPetar M SeferovićErwan DonalM NurmohamedMarco Matucci CerinicPetros P SfikakisGeorge D KitasJuerg SchwitterJoao Augusto Costa LimaDana DawsonMarc DweckKristina H HaugaaNiall KeenanJames MoonIvan StankovicErwan DonalBernard CosynsPublished in: European heart journal. Cardiovascular Imaging (2022)
Autoimmune rheumatic diseases (ARDs) involve multiple organs including the heart and vasculature. Despite novel treatments, patients with ARDs still experience a reduced life expectancy, partly caused by the higher prevalence of cardiovascular disease (CVD). This includes CV inflammation, rhythm disturbances, perfusion abnormalities (ischaemia/infarction), dysregulation of vasoreactivity, myocardial fibrosis, coagulation abnormalities, pulmonary hypertension, valvular disease, and side-effects of immunomodulatory therapy. Currently, the evaluation of CV involvement in patients with ARDs is based on the assessment of cardiac symptoms, coupled with electrocardiography, blood testing, and echocardiography. However, CVD may not become overt until late in the course of the disease, thus potentially limiting the therapeutic window for intervention. More recently, cardiovascular magnetic resonance (CMR) has allowed for the early identification of pathophysiologic structural/functional alterations that take place before the onset of clinically overt CVD. CMR allows for detailed evaluation of biventricular function together with tissue characterization of vessels/myocardium in the same examination, yielding a reliable assessment of disease activity that might not be mirrored by blood biomarkers and other imaging modalities. Therefore, CMR provides diagnostic information that enables timely clinical decision-making and facilitates the tailoring of treatment to individual patients. Here we review the role of CMR in the early and accurate diagnosis of CVD in patients with ARDs compared with other non-invasive imaging modalities. Furthermore, we present a consensus-based decision algorithm for when a CMR study could be considered in patients with ARDs, together with a standardized study protocol. Lastly, we discuss the clinical implications of findings from a CMR examination.
Keyphrases
- acute respiratory distress syndrome
- magnetic resonance
- extracorporeal membrane oxygenation
- high resolution
- mechanical ventilation
- disease activity
- pulmonary hypertension
- cardiovascular disease
- randomized controlled trial
- left ventricular
- decision making
- systemic lupus erythematosus
- rheumatoid arthritis
- study protocol
- atrial fibrillation
- end stage renal disease
- multiple sclerosis
- contrast enhanced
- heart failure
- chronic kidney disease
- ankylosing spondylitis
- clinical trial
- machine learning
- oxidative stress
- type diabetes
- computed tomography
- ejection fraction
- rheumatoid arthritis patients
- stem cells
- prognostic factors
- pulmonary artery
- peritoneal dialysis
- risk factors
- deep learning
- bone marrow
- coronary artery
- cardiovascular risk factors
- neural network
- health information
- physical activity
- juvenile idiopathic arthritis
- smoking cessation
- liver fibrosis