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Evaluation of myocardial involvement in patients with connective tissue disorders: a multi-parametric cardiovascular
Agnes Mayr1, Daniel Kitterer2, Joerg Latus2
1Division of Radiology, University Hospital Innsbruck, Innsbruck, Austria.
Insights
Cardiovascular magnetic resonance (CMR) mapping detects myocardial involvement in connective tissue disorders (CTD) patients. These advanced techniques show promise for early diagnosis, even when traditional markers are normal.
Area of Science:
- Cardiology
- Radiology
- Rheumatology
Background:
- Connective tissue disorders (CTD) can cause myocardial involvement, often presenting with subtle symptoms and normal cardiac function.
- Standard diagnostic methods like ECG and echocardiography may not detect early myocardial changes in CTD patients.
- Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) is useful for focal fibrosis but may miss diffuse myocardial involvement common in CTD.
Purpose of the Study:
- To evaluate a multi-parametric CMR protocol as a screening tool for myocardial involvement in CTD patients.
- To assess the incremental value of CMR mapping techniques beyond LGE in detecting subclinical myocardial disease in CTD.
Main Methods:
- Prospective enrollment of 40 CTD patients and 20 healthy volunteers for CMR.
- Utilized a multi-parametric CMR protocol including T1, T2 mapping, and extracellular volume (ECV) quantification.
- Compared CMR parameters between CTD patients and healthy controls.
Main Results:
- CTD patients exhibited significantly higher native T1, expanded ECV, and higher T2 values compared to controls.
- Prevalence of LGE was low (18%) in CTD patients, indicating limitations of LGE alone.
- Native T1 and T2 values were identified as the most promising discriminators for myocardial involvement in CTD.
Conclusions:
- CMR mapping techniques reveal significant differences in myocardial tissue characteristics in CTD patients compared to controls.
- Native T1 and T2 mapping are valuable, independent markers for detecting myocardial involvement in CTD, even in the absence of LGE.
- Multi-parametric CMR mapping offers incremental value for early and accurate diagnosis of myocardial involvement in CTD patients.
Background:
Severe arrhythmias or heart failure may be surrogates of myocardial involvement in patients with connective tissue disorders (CTD). However, most patients present with unspecific symptoms, normal ECG, and preserved left ventricular ejection fraction (LV-EF). Therefore, timely diagnosis by an accurate technique is crucial. Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) has proven value for the detection of focal processes, but due to the often diffuse character of fibrosis/inflammation in CTD patients, CMR mapping techniques might be of incremental value for the assessment of myocardial involvement. Purpose of this study was to evaluate a multi-parametric CMR protocol as a screening tool for myocardial involvement in CTD patients.
Methods:
Forty CTD patients were prospectively enrolled and underwent CMR, twenty healthy volunteers served as control group.
Results:
Mean LV-EF was 62 %; LGE prevalence was low (18 %). CTD patients had higher native T1 (1008 vs. 962 ms, p = 0.001), lower post contrast T1 (494 vs. 526 ms, p = 0.008), expanded extracellular volume (ECV) (28 vs. 25 %, p = 0.001), and higher T2 values (53 vs. 49 ms, p < 0.001) compared to controls. Among patients with values higher than the 95 % percentile of healthy controls, native T1 and T2 values seem to be the most promising discriminators.
Conclusion:
CTD patients showed higher T1, ECV, and T2 values compared to controls, with most significant differences for native T1 and T2, which seem to be independent of the presence of LGE. Our data suggest that CMR mapping techniques are of incremental value in the detection of myocardial involvement in CTD patients.
