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Rheumatology International
Published in: Rheumatology International 6/2018

01-06-2018 | Expert Opinion

Can cardiovascular magnetic resonance prompt early cardiovascular/rheumatic treatment in autoimmune rheumatic diseases? Current practice and future perspectives

Authors: Sophie I. Mavrogeni, Petros P. Sfikakis, Theodoros Dimitroulas, Loukia Koutsogeorgopoulou, Gikas Katsifis, George Markousis-Mavrogenis, Genovefa Kolovou, George D. Kitas

Published in: Rheumatology International | Issue 6/2018

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Abstract

Life expectancy in autoimmune rheumatic diseases (ARDs) remains lower compared to the general population, due to various comoborbidities. Cardiovascular disease (CVD) represents the main contributor to premature mortality. Conventional and biologic disease-modifying antirheumatic drugs (DMARDs) have considerably improved long-term outcomes in ARDs not only by suppressing systemic inflammation but also by lowering CVD burden. Regarding atherosclerotic disease prevention, EULAR has recommended tight disease control accompanied by regular assessment of traditional CVD risk factors and lifestyle changes. However, this approach, although rational and evidence-based, does not account for important issues such as myocardial inflammation and the long asymptomatic period that usually proceeds clinical manifestations of CVD disease in ARDs before or after the diagnosis of systemic disease. Cardiovascular magnetic resonance (CMR) can offer reliable, reproducible and operator independent information regarding myocardial inflammation, ischemia and fibrosis. Some studies suggest a role for CMR in the risk stratification of ARDs and demonstrate that oedema/fibrosis visualisation with CMR may have the potential to inform cardiac and rheumatic treatment modification in ARDs with or without abnormal routine cardiac evaluation. In this review, we discuss how CMR findings could influence anti-rheumatic treatment decisions targeting optimal control of both systemic and myocardial inflammation irrespective of clinical manifestations of cardiac disease. CMR can provide a different approach that is very promising for risk stratification and treatment modification; however, further studies are needed before the inclusion of CMR in the routine evaluation and treatment of patients with ARDs.
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Metadata
Title
Can cardiovascular magnetic resonance prompt early cardiovascular/rheumatic treatment in autoimmune rheumatic diseases? Current practice and future perspectives
Authors
Sophie I. Mavrogeni
Petros P. Sfikakis
Theodoros Dimitroulas
Loukia Koutsogeorgopoulou
Gikas Katsifis
George Markousis-Mavrogenis
Genovefa Kolovou
George D. Kitas
Publication date
01-06-2018
Publisher
Springer Berlin Heidelberg
Published in
Rheumatology International / Issue 6/2018
Print ISSN: 0172-8172
Electronic ISSN: 1437-160X
DOI
https://doi.org/10.1007/s00296-018-4004-6

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