Late gadolinium enhancement in patients with and without autoimmune rheumatic diseases: "walking, we create the way"

Myocardial fibrosis constitutes an important pathophysiologic and maladaptive process in the vast majority of cardiac diseases. Contemporary cardiologists are permitted a very nuanced glimpse of myocardial fibrosis by means of cardiovascular magnetic resonance imaging (CMR), and specifically late gadolinium enhancement (LGE) methods. These allow the evaluation of the presence, extent, and distribution of myocardial replacement fibrosis. An increasing amount of scientific evidence has demonstrated a significant role for LGE in the elucidation of cardiac pathophysiologic substrates in patients with autoimmune rheumatic diseases (ARDs) and cardiac involvement. However, whether existing methods for the evaluation of myocardial fibrosis can uniformly be extrapolated for use in patients with ARDs in their present form remains an important question. In this opinion paper, we provide a brief overview of the basic principles underlying LGE imaging, as well as the current status and challenges regarding its use in patients with and without ARDs.