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Cardiac involvement in patients with rheumatic disorders: Data of the RHEU-M(A)R study
Simon Greulich1, Daniel Kitterer2, Reto Kurmann3
1Division of Cardiology, Robert-Bosch-Medical Center, Stuttgart, Germany.
Insights
Cardiac involvement varies significantly across rheumatic disorders, with ANCA-associated vasculitis showing the highest prevalence. Late gadolinium enhancement-cardiac magnetic resonance imaging (LGE-CMR) reveals distinct LGE patterns for each rheumatic condition.
Area of Science:
- Cardiology
- Rheumatology
- Radiology
Background:
- Diagnosing cardiac involvement in rheumatic disorders is challenging due to varied clinical presentations.
- Cardiac involvement can lead to significant treatment changes and adverse long-term outcomes, necessitating risk stratification.
- Late gadolinium enhancement-cardiac magnetic resonance imaging (LGE-CMR) is a key tool for evaluating myocardial involvement.
Purpose of the Study:
- To determine the prevalence of cardiac involvement in patients with various rheumatic disorders using LGE-CMR.
- To investigate whether different rheumatic disorders exhibit distinct LGE patterns on cardiac MRI.
- To aid in individual risk stratification for cardiac complications in rheumatic diseases.
Main Methods:
- 297 patients with rheumatic disorders underwent LGE-CMR.
- Patients were categorized into five subgroups: ANCA-associated vasculitis, non-ANCA-associated vasculitis, connective tissue disorders, arthritis, and sarcoidosis.
- Cardiac involvement was defined by the presence of LGE in the myocardium.
Main Results:
- The overall population had a mean ejection fraction of 65% and a mean age of 55 years.
- Prevalence of cardiac involvement varied: ANCA-associated vasculitis (54%), non-ANCA-associated vasculitis (22%), connective tissue disorders (14%), arthritis (21%), and sarcoidosis (24%).
- Distinct LGE patterns were observed across the five rheumatic disorder subgroups.
Conclusions:
- Cardiac involvement prevalence ranges widely (14%-54%) among different rheumatic disorders.
- Distinct LGE patterns associated with specific rheumatic disorders were identified.
- LGE-CMR is valuable for assessing cardiac involvement and characterizing patterns in rheumatic diseases.
Background:
The diagnosis of cardiac involvement in rheumatic disorders is challenging due to its varying clinical presentation. Since clinical consequences range from immediate treatment changes to adverse long-term outcome, individual risk stratification is of great clinical interest. Primary aim was to evaluate the prevalence of cardiac involvement in patients with different rheumatic disorders using late gadolinium enhancement-cardiac magnetic resonance imaging (LGE-CMR). In addition, we sought to investigate if different rheumatic disorders would demonstrate different LGE patterns.
Methods:
Two-hundred-ninety-seven patients with rheumatic disorders were included and underwent LGE-CMR for work-up of cardiac involvement, which was defined by the presence of LGE in the myocardium. Patients were divided into five subgroups: 1) ANCA-associated vasculitis, 2) non-ANCA-associated vasculitis, 3) connective tissue disorders, 4) arthritis, and 5) sarcoidosis.
Results:
Mean ejection fraction in the overall population was 65%, with a mean age of 55yrs. Prevalence of cardiac involvement in the five subgroups were as follows: 54% in the ANCA-associated vasculitis group, 22% in the non-ANCA-associated vasculitis group, 14% in the group with connective tissue disorders, 21% in the arthritis group, and 24% in sarcoid patients. Each of the five subgroups demonstrated a distinct pattern of LGE.
Conclusion:
There is a wide range in the prevalence of cardiac involvement in different rheumatic disorders (54%-14%). Different groups of rheumatic disorders demonstrate different patterns of LGE.
Condensed Abstract:
Primary aim of the study was to evaluate the presence of cardiac involvement in patients with different rheumatic disorders using LGE-CMR. In addition, we sought to investigate if different rheumatic disorders would reveal different LGE patterns. In our 297 patients, the highest prevalence of cardiac involvement was found in patients with ANCA-associated vasculitis (54%), whereas the lowest prevalence was demonstrated in patients with connective tissue disorders (14%). Furthermore, different groups of rheumatic disorders demonstrate distinct patterns of LGE.
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