@article{3160272,
    title = "Cardiac Tissue Characterization and the Diagnostic Value of
Cardiovascular Magnetic Resonance in Systemic Connective Tissue Diseases",
    author = "Mavrogeni, Sophie and Sfikakis, Petros P. and Gialafos, Elias and and Bratis, Konstantinos and Karabela, Georgia and Stavropoulos, Efthymios and and Spiliotis, Georgios and Sfendouraki, Eliza and Panopoulos, Stylianos and and Bournia, Vasiliki and Kolovou, Genovefa and Kitas, George D.",
    journal = "ARTHRITIS & RHEUMATISM-ARTHRITIS CARE & RESEARCH",
    year = "2014",
    volume = "66",
    number = "1",
    pages = "104-112",
    publisher = "Wiley",
    doi = "10.1002/acr.22181",
    abstract = "ObjectiveAccurate diagnosis of cardiovascular involvement in connective
tissue diseases (CTDs) remains challenging. We hypothesized that
cardiovascular magnetic resonance (CMR) demonstrates cardiac lesions in
symptomatic CTD patients with normal echocardiography.
MethodsCMR from 246 CTD patients with typical cardiac symptoms (TCS; n =
146, group A) or atypical cardiac symptoms (ATCS; n = 100, group B) was
retrospectively evaluated. Group A included 9 patients with inflammatory
myopathy (IM), 35 with sarcoidosis, 30 with systemic sclerosis (SSc), 14
with systemic lupus erythematosus (SLE), 10 with rheumatoid arthritis
(RA), and 48 with small vessel vasculitis. Group B included 25 patients
with RA, 20 with SLE, 20 with sarcoidosis, 15 with SSc, 10 with IM, and
10 with small vessel vasculitis. CMR was performed by 1.5T; left
ventricular ejection fraction, T2 ratio (edema imaging), and late
gadolinium enhancement (LGE; fibrosis imaging) were evaluated. Acute and
chronic lesions were characterized as LGE positive plus T2 ratio >2 and
T2 ratio 2, respectively. According to LGE, lesions were characterized
as diffuse subendocardial, subepicardial, and subendocardial/transmural
due to vasculitis, myocarditis, and myocardial infarction, respectively.
A stress study by dobutamine echocardiography or stress, nuclear, or
adenosine CMR was performed in CTD patients with negative rest CMR.
ResultsAbnormal CMR was identified in 32% (27% chronic) and 15% (12%
chronic) of patients with TCS and ATCS, respectively. Lesions due to
vasculitis, myocarditis, and myocardial infarction were evident in
27.4%, 62.6%, and 9.6% of CTD patients, respectively. Stress studies
in CTD patients with negative CMR revealed coronary artery disease in
20%.
ConclusionCMR in symptomatic CTD patients with normal echocardiography
can assess disease acuity and identify vasculitis, myocarditis, and
myocardial infarction."
}