Advanced myocardial tissue characterisation by a multi-component CMR protocol in patients with rheumatoid arthritis

Abstract

ObjectivesRheumatoid arthritis (RA) patients are at increased risk of suffering from adverse cardiovascular events. Cardiovascular magnetic resonance (CMR) mapping techniques might be appropriate tools to complement late gadolinium enhancement (LGE) for the assessment of myocardial involvement. This study aimed to perform advanced myocardial tissue characterisation in RA patients by a multicomponent CMR protocol.Methods22 RA patients were prospectively enrolled and underwent CMR, including LGE and T1/T2 mapping sequences; 20 volunteers served as controls.ResultsMean LV-EF was 66%; prevalence of LGE was 18%. RA patients had increased native T1 (985 vs. 959 ms, p = 0.03), expanded extracellular volume (ECV) (27 vs. 25%, p = 0.02) and higher T2 values (52 vs. 49 ms, p < 0.001) compared to controls irrespective of the presence of LGE. T2 mapping showed the highest prevalence of values beyond the 95% percentile of controls.ConclusionRA patients demonstrated higher T1, ECV and T2 values compared to controls, with most significant differences for T2. Since these results seem to be independent of the presence of LGE, advanced myocardial tissue characterisation including CMR mapping techniques in addition to LGE-CMR might be useful in the evaluation of myocardial involvement in RA patients.Key points• RA patients had higher T1, ECV and T2 values compared to controls.• Most significant differences were observed for T2.• Our results seem to be independent of the presence of LGE.• Mapping might be useful in the evaluation of myocardial involvement in RA.

Early detection of myocardial involvement by T1 mapping of cardiac MRI in idiopathic inflammatory myopathy

“…The LGE technique at cardiac MRI is an accurate method to detect focal fibrosis with gadolinium‐based contrast agents and has proven to have significant prognostic implications in nonischemic cardiomyopathies . In our study, the LGE pattern localized in the midwall and/or the subepicardial layer, which was similar to previous reports as well as other autoimmune diseases . The incidence of LGE in our PM/DM cohort was 19%, with all patients having a nonischemic‐pattern of LGE, which was lower than previous studies showing the prevalence of LGE in 56.3–62.2% patients .…”

“…It is well recognized that T 1 mapping quantitatively represents diffuse myocardial damage . Many studies had demonstrated that T 1 mapping can be used to detect early myocardial involvement in rheumatic disorders, including systemic lupus erythematosus, systemic sclerosis, and rheumatoid arthritis . Our study demonstrated that PM/DM patients have higher myocardial native T 1 and ECV values than normal controls, which indicate the presence of subclinical myocardial involvement.…”

Performance of two Methods for Cardiac MRI Edema Mapping: Dual-Contrast Fast Spin-Echo and T2 Prepared Balanced Steady State Free Precession

“…This edema extent in STEMI patients may be used to evaluate the area at risk in clinical trials, but has only little impact on the clinical decision and outcome. However, detection of low-grade and diffuse edema is most important for the diagnosis of inflammatory cardiac diseases, such as myocarditis [5,[7][8][9], sarcoidosis [10], cardiac allograft rejection [11], connective tissue and rheumatic disorders [12,13] and myocardial involvement in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis [14]. Misinterpretation and overdiagnosis of edema is possible using T 1 contaminated methods such as dcFSE, especially in the case of T 1 elevation due to diffuse fibrosis or scar.…”

Chronic Heart Failure in Rheumatoid Arthritis Patients (Part II): Difficulties of Diagnosis

“…По данным S. Greulich и соавт. [7] у больных РА с сохраненной ФВ частота неишемических зон LGE составила 18%. Отмечено увеличение времени T1 и Т2, фракции внеклеточного объема по сравнению с контролем, независимо от наличия LGE.…”

“…[5] показали, что 47% пациентов с РА имеют ограничение подвижности из-за функциональной недостаточности суставов, и лишь 16% -в связи с одышкой. С другой стороны, по данным стандартизованных опросников, не менее 40% больных РА указывают на одышку при нагрузке или отеки, при этом частота симптомов коррелирует с активностью заболевания [6,7]. В работе T. Sсhau и соавт.…”