Deciphering cardiac involvement in systemic inflammatory diseases: noninvasive tissue characterisation using cardiac magnetic resonance is key to improved patients’ care

Abstract

Cardiac involvement in systemic inflammatory diseases (SID) has a major impact on patients' morbidity and mortality, yet the pathways to its recognition and management remain poorly established. Areas covered: Overall clinical management in SID patients is primarily guided by systemic symptoms. Cardiovascular disease goes largely undetected, as it evolves through years of a protracted and subclinical course. Despite the increased awareness and insights into the mechanistic role of the inflammatory pathways, clinical management of cardiac involvement continues to rely on diagnostic means, which are frequently insensitive, invasive and rely on radiation exposure. Advanced tissue characterisation with cardiovascular magnetic resonance (CMR) offers an accurate, non-invasive and radiation-free diagnostic method with obvious advantages: it is able to inform on a range of cardiovascular pathophysiology, as well as support safe serial examinations, informing on the disease presence, progress and response to treatment. Expert commentary: We summarise the recent advances in non-invasive imaging, and bridge the novel insights into pathophysiology with future posibilities in diagnosis and manangement of SID patients. We propose an interdisciplinary framework to screening of cardiac involvement in SID using an indepth phenotyping of evolution of cardiovascular disease, to decipher the opportunities to improve patients' cardiac care.

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

“…The majority of RA patients were female and asymptomatic to mildly symptomatic [ 5 ] (Table 1 ). Although dyspnoea was reported in 41% of the RA patients, it is difficult to separate dyspnoea suggestive of cardiac origin from dyspnoea due to low physical activity, since RA patients are often severely affected by articular and extra-articular manifestations, hampering them in their daily lives [ 5 ].…”

“…RA may involve the heart, and patients show a reduced average lifespan by 8–15 years primarily due to adverse cardiovascular events [ 2 , 3 ]. Beside an increased risk of premature atherosclerosis even in the absence of traditional risk factors (RA is regarded as a cardiovascular risk factor equal to diabetes mellitus) [ 4 ], ongoing autoimmune, inflammatory and fibrotic processes are supposed to account for (1) symptoms of heart failure, (2) diastolic dysfunction, (3) dilated ventricles with reduced left ventricular ejection fraction (LV-EF) and (4) arrhythmia, resulting in significant cardiovascular co-morbidity and mortality [ 5 – 7 ]. Since patients with RA often run a subclinical course before overt cardiac involvement might manifest [ 2 , 5 , 8 , 9 ], non-invasive advanced tissue characterisation in early, potential modifiable stages of the disease is highly desirable.…”

“…Beside an increased risk of premature atherosclerosis even in the absence of traditional risk factors (RA is regarded as a cardiovascular risk factor equal to diabetes mellitus) [ 4 ], ongoing autoimmune, inflammatory and fibrotic processes are supposed to account for (1) symptoms of heart failure, (2) diastolic dysfunction, (3) dilated ventricles with reduced left ventricular ejection fraction (LV-EF) and (4) arrhythmia, resulting in significant cardiovascular co-morbidity and mortality [ 5 – 7 ]. Since patients with RA often run a subclinical course before overt cardiac involvement might manifest [ 2 , 5 , 8 , 9 ], non-invasive advanced tissue characterisation in early, potential modifiable stages of the disease is highly desirable. T1 and T2 CMR mapping sequences, which perform well in the detection of subtle myocardial fibrotic/inflammatory processes [ 10 – 12 ], and assess quantitatively myocardial tissue properties in absolute terms, might complement the performance from established late gadolinium enhancement (LGE)-CMR, for the evaluation of cardiac involvement in RA patients.…”

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

“…Moreover, the reported mortality due to cardiac involvement in adult onset IIM varies from 14–55%, even in subclinical types. Although cardiac involvement is not rare in IIM, early detection of subclinical myocardial abnormalities that may lead to the development of preventive intervention remains challenging.…”

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

“…МРТ способствует верификации диагноза миокардита, васкулита, перенесенного инфаркта миокарда, нарушений микроциркуляции и перфузии миокарда, выявлению фиброза миокарда [66][67][68]. Классический протокол МРТ сердца включает в себя [69]:…”