IMR Press / RCM / Volume 15 / Issue 4 / DOI: 10.3909/ricm0724
Open Access Review
Why Currently Used Diagnostic Techniques for Heart Failure in Rheumatoid Arthritis Are Not Enough: The Challenge of Cardiovascular Magnetic Resonance Imaging
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1 Onassis Cardiac Surgery Center, Athens, Greece
2 Department of Rheumatology, Russells Hall Hospital, West Midlands, United Kingdom
3 Department of Health Sciences Research and Division of Rheumatology, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, MN
4 First Department of Propaedeutic and Internal Medicine, Laikon Hospital, Athens University Medical School, Athens, Greece
5 Keck School of Medicine, University of Southern California, Los Angeles, CA, Loma Linda University, Loma Linda, CA, Westside Medical Imaging, Beverly Hills, CA
6 Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, United Kingdom
Rev. Cardiovasc. Med. 2014 , 15(4), 320–331; https://doi.org/10.3909/ricm0724
Published: 30 December 2014
Abstract
Rheumatoid arthritis (RA) is a multiorgan inflammatory disorder affecting approximately 1% of the population that leads to progressive joint destruction and disability. Patients with RA exhibit a high risk of cardiovascular disease, which results in premature morbidity and mortality and reduced life expectancy, when compared with the general population. Among various guises of myocardial involvement, heart failure (HF) has been recently recognized as an important contributory factor to the excess cardiovascular mortality associated with RA. HF in RA typically presents with occult clinical symptomatology and is mainly associated with structural and functional left ventricular abnormalities leading to diastolic dysfunction, while systolic myocardial performance remains well preserved. As isolated diastolic dysfunction is a predictor of high mortality, the evaluation of patients in early asymptomatic stages, when treatment targeting the heart is more likely to be effective, is of great importance. Although patient history and physical examination remain the cornerstones of HF evaluation, noninvasive imaging of cardiac chambers, coronary arteries, and great vessels may be necessary. Echocardiography, nuclear techniques, and invasive coronary angiography are already established in the routine assessment of HF; however, many aspects of HF pathophysiology in RA remain obscure, due to the limitations of currently used techniques. The capability of cardiovascular magnetic resonance (CMR) to capture early tissue changes allows timely detection of pathophysiologic phenomena of HF in RA, such as myocardial inflammation and myocardial perfusion defects, due to either macrovascular (coronary artery disease) or microvascular (vasculitis) disease. Therefore, CMR may be a useful tool for early, accurate diagnosis and research in patients with RA.
Keywords
Rheumatoid arthritis
Myocarditis
Vasculitis
Coronary artery disease
Heart failure
Echocardiography
Nuclear cardiology
Computed tomography
Cardiac magnetic resonance
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