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Myocardial Involvement in Rheumatic Disorders

  • Imaging in Heart Failure (J Schulz-Menger, Section Editor)
  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Autoimmune rheumatic diseases (ARDs) affect 8% of the population and approximately 78% of patients are women. Myocardial disease in ARDs is the endpoint of various pathophysiologic mechanisms including atherosclerosis, valvular disease, systemic, myocardial, and/or vascular inflammation, as well as myocardial ischemia and replacement/diffuse fibrosis.

Recent Findings

The increased risk of CVD in ARDs leads to excess comorbidity not fully explained by traditional cardiovascular risk factors. It seems that the chronic inflammatory status typically seen in ARDs, promotes both the development of myocardial inflammation/fibrosis and the acceleration of atherosclerosis.

Summary

CMR (cardio-vascular magnetic resonance) is the ideal imaging modality for the evaluation of cardiac involvement in patients with ARDs, as it can simultaneously assess cardiac function and characterize myocardial tissues with regard to oedema and fibrosis. Due to its high spatial resolution, CMR is capable of identifying various disease entities such as myocardial oedema /inflammation, subendocardial vasculitis and myocardial fibrosis, that are often missed by other imaging modalities, notably at an early stage of development. Although generally accepted guidelines about the application of CMR in ARDs have not yet been formulated, according to our experience and the available published literature, we recommend CMR in ARD patientS with new-onset heart failure (HF), arrhythmia, for treatment evaluation/change or if there is any mismatch between patient symptoms and routine non-invasive evaluation.

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Authors and Affiliations

  1. Onassis Cardiac Surgery Center, 50 Esperou Street, 175-61, P. Faliro, Athens, Greece

    George Markousis-Mavrogenis, Urania Kariki, Dionysia Manolopoulou, Vasiliki Vartela, Genovefa Kolovou & Sophie I. Mavrogeni

  2. Magnetic Resonance Imaging Unit, Fondazione G. Monasterio C.N.R, Pisa, Italy

    Alessia Pepe

  3. Institute of Clinical Physiology, National Research Council, Pisa, Italy

    Luna Gargani

  4. Dpt of Cardiology, Laikon Hospital, Athens, Greece

    Maria Bonou

  5. Dpt Pathophysiology, Laikon Hospital, Athens, Greece

    Loukia Koutsogeorgopoulou

  6. Joint Rheumatology, Laikon Hospital, National Kapodistrian University of Athens, Medical School, Athens, Greece

    Maria G. Tektonidou

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  1. George Markousis-Mavrogenis
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Correspondence to Sophie I. Mavrogeni.

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This article is part of Topical Collection on Imaging in Heart Failure

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Markousis-Mavrogenis, G., Pepe, A., Gargani, L. et al. Myocardial Involvement in Rheumatic Disorders. Curr Heart Fail Rep 17, 171–180 (2020). https://doi.org/10.1007/s11897-020-00471-1

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