Cardiac involvement detected by CMR varies widely among rheumatic disorders, being most common in ANCA-associated vasculitis and least common in autoimmune connective tissue disorders.
CMR detects subclinical cardiac involvement across rheumatic diseases with varying prevalence; leaves open whether routine screening alters management or outcomes.
Purpose: There is much controversy about the prevalence of cardiac involvement in patients with rheumatic disorders. This is of importance, since consequences of cardiac involvement range from different treatment regimes to adverse outcomes. Consequently, our primary aim was to evaluate the prevalence of cardiac involvement in different forms of rheumatic disorders by CMR. Methods: 297 patients underwent CMR. Cardiac involvement was defined by presence of late gadolinium enhancement (LGE). Patients with a history of myocardial infarction and/ or prior revascularization procedure were excluded. Patients were further divided into 5 subgroups: (1) ANCA associated vasculitis, (2) non-ANCA associated vasculitis, (3) autoimmune connective tissue disorders, (4) arthritis, and (5) sarcoidosis. Results: We enrolled n 63 patients in the ANCA associated vasculitis group, 34 of them (54%) were LGE positive. LGE showed a non-ischemic pattern in 33 patients (97%), isolated ischemic LGE pattern was present in only 1 patient. The Non-ANCA associated vasculitis group consisted of 32 patients, in 7 patients (22%) LGE could be detected. LGE was non-ischemic in 6 patients (86%), isolated ischemic LGE was present in only 1 patient. In the group with connective tissue disorders 15 out of 110 patients (14%) showed LGE: Of these, 13 patients (87%) showed non-ischemic LGE, 2 patients isolated ischemic LGE, 2 patients had both non-ischemic and ischemic pattern. The Arthritis group consisted of 47 patients, in 10 of them (21%) LGE was detected. Non-ischemic LGE pattern was found in 8 patients (80%), ischemic LGE was present in 3 patients (30%), in one patient LGE-CMR revealed both LGE patterns. 45 patients were in the sarcoid group, 11 of them (24%) showed LGE: 8 patients had non-ischemic LGE (73%), 3 patients ischemic LGE (27%). Comparing prevalence of cardiac involvement in the five different rheumatic subgroups, the highest prevalence of cardiac involvement (54%) was detected in patients with ANCA-associated vasculitis. Conversely, in our cohort of autoimmune connective tissue disorders, LGE CMR revealed the lowest prevalence of cardiac involvement. Conclusion: There is a wide variation in the prevalence of cardiac involvement in different groups with rheumatic disorders. In patients with ANCA associated vasculitis cardiac involvement seems to be common (54%), whereas patients with autoimmune connective tissue disorders seem to have a low prevalence of cardiac involvement (14%).
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Greulich et al. (2016) studied this question.
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