Usefulness of cardiovascular biomarkers and cardiac imaging in systemic rheumatic diseases

Systemic rheumatic diseases (SRDs) are associated with accelerated atherosclerosis. It has recently been recognised that chronic inflammation is an important factor in the development of atherosclerotic plaque and endothelial dysfunction. The levels of biomarkers such as serum pentraxin 3 (PTX3), an innate immunity protein, and asymmetric dimethylarginine (ADMA), an endogenous inhibitor of NO synthase, are higher in SRD  patients with cardiovascular (CV) disease and are now recognized as new CV risk factors. Many diagnostic methods and imaging techniques detect subtle pre-clinical CV abnormalities in SRD patients, although their clinical significance has not yet been established in patients. Echocardiographic examinations based on the evaluation of coronary flow reserve (CFR), tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) seem to be the most suitable means of screening and diagnosis. Furthermore, plasma ADMA levels could be used as a simple means of screening SRD patients at higher CV risk who need more aggressive treatment aimed at slowing or reversing the progression of atherosclerosis.