Early diagnosis of cardiac involvement in idiopathic inflammatory myopathy by cardiac magnetic resonance tomography

Abstract

The aim of this study was to investigate cardiac involvement in patients with idiopathic inflammatory myopathies excluding inclusion body myositis with cardiac magnetic resonance tomography (CMR). A case series of 53 patients with polymyositis, dermatomyositis, or non-specific myositis underwent CMR including functional imaging, T1-weighted, and late gadolinium enhancement (LGE) imaging. T1-weighted and LGE images were analyzed for myocardial enhancement. Reduced left ventricular function (LVF) was found in 9 (7%) patients. Patients with reduced LVF more often presented with early and late myocardial enhancement (p = 0.014 and p = 0.001). In 33 (62.3%) patients, LGE was observed by CMR. These patients had significantly lower left ventricular ejection fractions (p < 0.001) compared to patients without LGE. LGE was mainly present in the lateral (p < 0.01) and inferior (p < 0.02) segments. No correlations of LGE presence or reduced LVF to cardiovascular risk factors were found. Myocardial inflammation is very frequent in polymyositis, dermatomyositis, and non-specific myositis. In our patient, cohort CMR demonstrated signs of myocardial inflammation in 62.3%. CMR seems to offer a measurable and quantifiable diagnostic tool for cardiac involvement of idiopathic inflammatory myopathies and can thus be used to monitor disease progress and therapeutic success in these patients.

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 .…”

“…Cardiac magnetic resonance imaging (MRI) is a valuable noninvasive imaging modality for evaluation of myocardial inflammation in myocarditis and in assessment of myocardial involvement in autoimmune disease . Recent uncontrolled data showed a high proportion (56–62%) of IIM patients presenting with late gadolinium enhancement (LGE), indicating focal fibrosis . However, the detection of LGE depended on the comparison of damaged myocardium against distant “normal” myocardium, which is a suboptimal technique for detecting diffuse myocardial fibrosis.…”

Multiparametric cardiovascular magnetic resonance characteristics and dynamic changes in myocardial and skeletal muscles in idiopathic inflammatory cardiomyopathy

“…Clinical manifestations of cardiac involvement in IIM patients can range from none to arrhythmia, heart failure, and even cardiac death [5]. Previous studies have found cardiac involvement manifesting as diastolic dysfunction or decreased longitudinal strain by echocardiography [6,7], abnormalities on electrocardiography (ECG) [6], presence of myocardial late gadolinium enhancement (LGE) [3,8,9], increased myocardial T1and T2 values [10][11][12], and increased extracellular volume (ECV) [13] by cardiovascular magnetic resonance (CMR). Although a few previous studies have reported the potential value of multiparametric CMR techniques in identifying cardiac involvement in patients with IIM [10,11], there is still a lack of dynamic monitoring of myocardial histological changes during therapy.…”

Cardiopulmonary factors affecting 6-min walk distance in patients with idiopathic inflammatory myopathies

“…Heart involvement in idiopathic inflammatory myopathies was also detected by cardiac magnetic resonance tomography [5] or echocardiography [6], and these findings may lead to therapeutic treatment for the cause of morbidity [7]. An increased risk of myocardial infarction or conduction abnormalities was reported in patients with idiopathic inflammatory myopathies [8].…”

“…An increased risk of myocardial infarction or conduction abnormalities was reported in patients with idiopathic inflammatory myopathies [8]. Moreover, left ventricular diastolic dysfunction [6] and reduced left ventricular ejection fractions (EF) [5] were observed in patients regardless of the presence of myalgia, paresis, and exhaustion. Few studies have demonstrated the relationship between cardiac functions and exercise capacity in patients with idiopathic inflammatory myopathies.…”