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Cardiovascular Magnetic Resonance Detects Inflammatory Cardiomyopathy in Symptomatic Patients with Inflammatory Joint

George Markousis-Mavrogenis1, Maria Bonou2, Vasiliki Vartela1

  • 1Onassis Cardiac Surgery Center, 17674 Athens, Greece.

Journal of Clinical Medicine
|March 10, 2022
PubMed

Insights

Cardiovascular magnetic resonance (CMR) detects significant cardiac inflammation in patients with inflammatory joint diseases (IJD) who have unexplained symptoms. This imaging technique is valuable for identifying myocardial abnormalities when routine tests are inconclusive.

Area of Science:

  • Cardiology
  • Rheumatology
  • Medical Imaging

Background:

  • Patients with inflammatory joint diseases (IJD) face a higher risk of cardiovascular disease.
  • Routine clinical evaluations often fail to detect cardiac abnormalities in IJD patients with atypical symptoms.
  • Cardiovascular magnetic resonance (CMR) is explored for its potential to identify subclinical cardiac issues in this population.

Purpose of the Study:

  • To investigate the utility of CMR in detecting cardiac abnormalities in patients with IJD and unexplained symptoms.
  • To compare CMR findings between IJD patients and a control group with similar symptoms but no IJD.

Main Methods:

  • 51 IJD patients (rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis) with normal baseline cardiac workups underwent CMR.
  • 40 non-IJD controls with similar atypical cardiac symptoms were also evaluated using CMR.
  • CMR utilized 1.5 T or 3.0 T systems, including T1/T2 mapping and gadolinium enhancement sequences.

Main Results:

  • 49% of IJD patients showed replacement-type myocardial fibrosis, compared to 0% in controls (p < 0.001).
  • IJD patients exhibited significantly higher T2 signal ratios, gadolinium enhancement, and extracellular volume fractions.
  • Native T1 mapping was significantly elevated in IJD patients, irrespective of MRI field strength (p < 0.001).

Conclusions:

  • CMR effectively identifies myocardial inflammation in IJD patients with cardiac symptoms discordant with standard evaluations.
  • The findings suggest CMR is a valuable tool for assessing cardiac involvement in IJD patients.
  • Consideration of CMR is recommended for IJD patients presenting with unexplained cardiac symptoms.

Keywords:
C-reactive proteinT1 mappingankylosing spondylitisechocardiographyextracellular volume fractionlate gadolinium enhancementpsoriatic arthritisrheumatoid arthritis

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