Cardiac Disease in Rheumatoid Arthritis — Can Cardiovascular Magnetic Resonance Imaging Depict the Janus Duality?

Rheumatoid arthritis (RA) is associated with premature mortality mainly attributed to cardiovascular disease (CVD)1,2. Although ischemic heart disease was initially considered as the main cause of heart failure (HF) in this population3,4,5, it failed to completely explain the high incidence of HF in RA. Over time, myocardial inflammation and/or fibrosis have become increasingly recognized as important pathophysiologic components underlining HF in patients with RA6,7. Cardiovascular magnetic resonance imaging (cMRI) is a noninvasive modality capable of using radiowave pulse sequences to characterize myocardial tissues regarding fibrosis and inflammation without the need for ionizing radiation exposure. Studies of cMRI suggested that a subset of patients with RA have focal scarring detected by late gadolinium enhancement (LGE) and diffuse fibrosis and increased extracellular volume (ECV) detected by T1 mapping8,9,10,11. However, these studies were small and included few patients taking biological therapy. The inclusion of new cMRI indices in clinical practice, as proposed by the joint Society for Cardiovascular Magnetic Resonance/European Association for … Address correspondence to Dr. S.I. Mavrogeni, 50 Esperou St., 175-61, P. Faliro, Athens, Greece. E-mail: soma13{at}otenet.gr