EACVI survey on the use of multi-modality cardiovascular imaging in immune-mediated inflammatory diseases

To scope the current European landscape of multi-modality cardiovascular imaging practices in immune-mediated inflammatory diseases (IMIDs).

An electronic (e)-survey was distributed to members of the European Association of Cardiovascular Imaging (EACVI) about imaging in cardio-rheumatology. A parallel e-survey focused on the use of coronary computed tomography (CT) for cardiovascular disease (CVD) risk stratification in IMIDs was conducted via the British Society of Cardiovascular Imaging (BSCI). Of the total 111 respondents to the EACVI survey, 92 (82.9%) were consultant-grade physicians and 68 (61.3%) worked in tertiary centres. These individuals had varied experiences in cardio-rheumatology, with limited access to dedicated cardio-rheumatology services and training opportunities. Sixty-nine (62.2%) used coronary CT to guide preventive therapies in IMID patients with borderline risk scores and cardiac symptoms, with a preference for coronary CT angiography over coronary artery calcium scoring alone in this setting. These findings about coronary CT were corroborated in the parallel survey of 54 BSCI members. When using cardiovascular magnetic resonance imaging (CMR) to detect myocardial involvement in IMIDs, 73/111 (67.6%) perceived a need for IMID-specific CMR criteria beyond the current modified Lake Louise criteria for myocarditis. In terms of nuclear imaging, timely access to ¹⁸F-fluorodeoxyglucose positron emission tomography imaging was identified as a barrier for diagnosing large-vessel vasculitis, and 61/111 (57%) of responders felt that the development of novel radionuclide tracers should be a future research priority.

This European survey highlights the need for dedicated cardio-rheumatology services and specialist training, and further evidence to inform future clinical practice recommendations on multi-modality cardiovascular imaging in IMIDs.