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Buch MH, Mallat Z, Dweck MR, Tarkin JM, O'Regan DP, Ferreira V, Youngstein T, Plein S. Current understanding and management of cardiovascular involvement in rheumatic immune-mediated inflammatory diseases. Nat Rev Rheumatol 2024:10.1038/s41584-024-01149-x. [PMID: 39232242 DOI: 10.1038/s41584-024-01149-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2024] [Indexed: 09/06/2024]
Abstract
Immune-mediated inflammatory diseases (IMIDs) are a spectrum of disorders of overlapping immunopathogenesis, with a prevalence of up to 10% in Western populations and increasing incidence in developing countries. Although targeted treatments have revolutionized the management of rheumatic IMIDs, cardiovascular involvement confers an increased risk of mortality and remains clinically under-recognized. Cardiovascular pathology is diverse across rheumatic IMIDs, ranging from premature atherosclerotic cardiovascular disease (ASCVD) to inflammatory cardiomyopathy, which comprises myocardial microvascular dysfunction, vasculitis, myocarditis and pericarditis, and heart failure. Epidemiological and clinical data imply that rheumatic IMIDs and associated cardiovascular disease share common inflammatory mechanisms. This concept is strengthened by emergent trials that indicate improved cardiovascular outcomes with immune modulators in the general population with ASCVD. However, not all disease-modifying therapies that reduce inflammation in IMIDs such as rheumatoid arthritis demonstrate equally beneficial cardiovascular effects, and the evidence base for treatment of inflammatory cardiomyopathy in patients with rheumatic IMIDs is lacking. Specific diagnostic protocols for the early detection and monitoring of cardiovascular involvement in patients with IMIDs are emerging but are in need of ongoing development. This Review summarizes current concepts on the potentially targetable inflammatory mechanisms of cardiovascular pathology in rheumatic IMIDs and discusses how these concepts can be considered for the diagnosis and management of cardiovascular involvement across rheumatic IMIDs, with an emphasis on the potential of cardiovascular imaging for risk stratification, early detection and prognostication.
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Affiliation(s)
- Maya H Buch
- Centre for Musculoskeletal Research, Division of Musculoskeletal & Dermatological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
| | - Ziad Mallat
- Section of Cardiorespiratory Medicine, Victor Phillip Dahdaleh Heart & Lung Research Institute, University of Cambridge, Cambridge, UK
| | - Marc R Dweck
- Centre for Cardiovascular Science, Chancellors Building, Little France Crescent, University of Edinburgh, Edinburgh, UK
| | - Jason M Tarkin
- Section of Cardiorespiratory Medicine, Victor Phillip Dahdaleh Heart & Lung Research Institute, University of Cambridge, Cambridge, UK
| | - Declan P O'Regan
- MRC Laboratory of Medical Sciences, Imperial College London, London, UK
| | - Vanessa Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Taryn Youngstein
- National Heart & Lung Institute, Imperial College London, London, UK
- Department of Rheumatology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Sven Plein
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, UK
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2
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Zainal H, Rolf A, Zhou H, Vasquez M, Escher F, Keller T, Vasa-Nicotera M, Zeiher AM, Schultheiss HP, Nagel E, Puntmann VO. Comparison of diagnostic algorithms in clinically suspected viral myocarditis: agreement between cardiac magnetic resonance, endomyocardial biopsy and troponin T. J Cardiovasc Magn Reson 2024:101087. [PMID: 39191369 DOI: 10.1016/j.jocmr.2024.101087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 07/01/2024] [Accepted: 08/16/2024] [Indexed: 08/29/2024] Open
Abstract
AIMS Myocardial inflammation is increasingly detected non-invasively by tissue mapping with cardiovascular magnetic resonance (CMR). Intraindividual agreement with endomyocardial biopsy (EMB) or marker of myocardial injury, high-sensitive troponin (hs-cTnT) in patients with clinically suspected viral myocarditis not understood. METHODS AND RESULTS Prospective multicentre study of consecutive patients with clinically suspected myocarditis who underwent blood testing for hs-cTnT, CMR and EMB as a part of diagnostic work-up. EMB was considered positive based on immunohistological criteria in line with the ESC definitions. CMR diagnoses employed tissue mapping using sequence-specific cut-off for native T1 and T2 mapping; active inflammation was defined as T1≥2SD and T2≥2SD above the mean of normal range. Hs-cTnT of greater than 13.9ng/1 was considered significant. A total of 114 patients (age (mean±SD) 54±16, 65% males) were included, of which 79(69%) had positive EMB-criteria, 64(56%) CMR criteria, and a total of 58 (51%) positive troponin. Agreement between EMB and CMR diagnostic criteria was poor (CMR vs. ESC: AUCs: 0.51 (0.39-0.62)). The agreement between the significant hs-cTnT rise and CMR-based diagnosis of myocarditis was good (AUC: 0.84 (0.68-0.92); p<0.001), but poor for EMB (0.50 (0.40-0.61). Hs-cTnT was significantly associated with native T1 and T2, hs-CRP and NT-pro BNP (r=0.37, r=0.35, r=0.30, r=0.25 p<0.001), but not immunohistochemical criteria or viral presence. CONCLUSIONS In clinically suspected viral myocarditis, all diagnostic approaches reflect the pathophysiological elements of myocardial inflammation, however the differing underlying drivers only partially overlap. The EMB and CMR diagnostic algorithms are neither interchangeable in terms of interpretation of myocardial inflammation nor in their relationship with myocardial injury.
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Affiliation(s)
- Hafisyatul Zainal
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Cardiology, Universiti Teknologi MARA (UiTM), Sg. Buloh, Malaysia
| | - Andreas Rolf
- Department of Cardiology, Kerckhoff Hospital, University Giessen, Bad Nauheim, Germany
| | - Hui Zhou
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Radiology, XiangYa Hospital, Central South University, Changsha, Hunan, China
| | - Moises Vasquez
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Cardiology Department, Enrique Baltodano Briceño Hospital, Liberia, Costa Rica
| | | | - Till Keller
- Department of Cardiology, Kerckhoff Hospital, University Giessen, Bad Nauheim, Germany
| | - Mariuca Vasa-Nicotera
- Department of Cardiac regeneration, Goethe University Frankfurt, Frankfurt-am Main, Germany
| | - Andreas M Zeiher
- Department of Cardiac regeneration, Goethe University Frankfurt, Frankfurt-am Main, Germany
| | | | - Eike Nagel
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Valentina O Puntmann
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Cardiac regeneration, Goethe University Frankfurt, Frankfurt-am Main, Germany.
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Muser D, Chahal AA, Selvanayagam JB, Nucifora G. Clinical Applications of Cardiac Magnetic Resonance Parametric Mapping. Diagnostics (Basel) 2024; 14:1816. [PMID: 39202304 PMCID: PMC11353869 DOI: 10.3390/diagnostics14161816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/03/2024] [Accepted: 07/01/2024] [Indexed: 09/03/2024] Open
Abstract
Cardiovascular magnetic resonance (CMR) imaging is widely regarded as the gold-standard technique for myocardial tissue characterization, allowing for the detection of structural abnormalities such as myocardial fatty replacement, myocardial edema, myocardial necrosis, and/or fibrosis. Historically, the identification of abnormal myocardial regions relied on variations in tissue signal intensity, often necessitating the use of exogenous contrast agents. However, over the past two decades, innovative parametric mapping techniques have emerged, enabling the direct quantitative assessment of tissue magnetic resonance (MR) properties on a voxel-by-voxel basis. These mapping techniques offer significant advantages by providing comprehensive and precise information that can be translated into color-coded maps, facilitating the identification of subtle or diffuse myocardial abnormalities. As unlikely conventional methods, these techniques do not require a substantial amount of structurally altered tissue to be visually identifiable as an area of abnormal signal intensity, eliminating the reliance on contrast agents. Moreover, these parametric mapping techniques, such as T1, T2, and T2* mapping, have transitioned from being primarily research tools to becoming valuable assets in the clinical diagnosis and risk stratification of various cardiac disorders. In this review, we aim to elucidate the underlying physical principles of CMR parametric mapping, explore its current clinical applications, address potential pitfalls, and outline future directions for research and development in this field.
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Affiliation(s)
- Daniele Muser
- Cardiac Electrophysiology Unit, Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy;
- Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Anwar A. Chahal
- Center for Inherited Cardiovascular Diseases, WellSpan Health, Lancaster, PA 17601, USA;
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London E1 1BB, UK
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Joseph B. Selvanayagam
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, SA 5042, Australia;
| | - Gaetano Nucifora
- Cardiac Imaging Unit, NorthWest Heart Centre, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester M13 9PL, UK
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4
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Fleischer S, Nash TR, Tamargo MA, Lock RI, Venturini G, Morsink M, Graney PL, Li V, Lamberti MJ, Liberman M, Kim Y, Tavakol DN, Zhuang RZ, Whitehead J, Friedman RA, Soni RK, Seidman JG, Seidman CE, Geraldino-Pardilla L, Winchester R, Vunjak-Novakovic G. An engineered human cardiac tissue model reveals contributions of systemic lupus erythematosus autoantibodies to myocardial injury. NATURE CARDIOVASCULAR RESEARCH 2024:10.1038/s44161-024-00525-w. [PMID: 39195859 DOI: 10.1038/s44161-024-00525-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 07/18/2024] [Indexed: 08/29/2024]
Abstract
Systemic lupus erythematosus (SLE) is a heterogenous autoimmune disease that affects multiple organs, including the heart. The mechanisms of myocardial injury in SLE remain poorly understood. In this study, we engineered human cardiac tissues and cultured them with IgG from patients with SLE, with and without myocardial involvement. IgG from patients with elevated myocardial inflammation exhibited increased binding to apoptotic cells within cardiac tissues subjected to stress, whereas IgG from patients with systolic dysfunction exhibited enhanced binding to the surface of live cardiomyocytes. Functional assays and RNA sequencing revealed that, in the absence of immune cells, IgG from patients with systolic dysfunction altered cellular composition, respiration and calcium handling. Phage immunoprecipitation sequencing (PhIP-seq) confirmed distinctive IgG profiles between patient subgroups. Coupling IgG profiling with cell surfaceome analysis identified four potential pathogenic autoantibodies that may directly affect the myocardium. Overall, these insights may improve patient risk stratification and inform the development of new therapeutic strategies.
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Affiliation(s)
- Sharon Fleischer
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Trevor R Nash
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Manuel A Tamargo
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Roberta I Lock
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | | | - Margaretha Morsink
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Pamela L Graney
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Vanessa Li
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Morgan J Lamberti
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Martin Liberman
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Youngbin Kim
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Daniel N Tavakol
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Richard Z Zhuang
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Jaron Whitehead
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Richard A Friedman
- Biomedical Informatics Shared Resource, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Rajesh K Soni
- Proteomics and Macromolecular Crystallography Shared Resource, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | | | - Christine E Seidman
- Department of Genetics, Harvard Medical School, Boston, MA, USA
- Division of Cardiovascular Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | | | - Robert Winchester
- Department of Medicine, Columbia University, New York, NY, USA
- Columbia Center for Translational Immunology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Gordana Vunjak-Novakovic
- Department of Biomedical Engineering, Columbia University, New York, NY, USA.
- Department of Medicine, Columbia University, New York, NY, USA.
- College of Dental Medicine, Columbia University, New York, NY, USA.
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5
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Wang W, Gao Y, Gao J. A case report of severe hypersensitivity reactions after belimumab infusion with complicated acute myocarditis. Int J Rheum Dis 2024; 27:e15232. [PMID: 38874106 DOI: 10.1111/1756-185x.15232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/16/2024] [Accepted: 06/06/2024] [Indexed: 06/15/2024]
Affiliation(s)
- Wei Wang
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yuan Gao
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jie Gao
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Kadoglou NPE, Dimopoulou A, Gkougkoudi E, Parperis K. Altered Arterial Stiffness, Ventricular-Arterial Coupling and Troponin Levels in Patients with Systemic Lupus Erythematosus. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:821. [PMID: 38793004 PMCID: PMC11122872 DOI: 10.3390/medicina60050821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/08/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024]
Abstract
Introduction: Systemic Lupus Erythematosus (SLE) is an autoimmune disease associated with an increased risk of cardiovascular diseases (CVDs), leading to elevated mortality rates among patients. We aimed to evaluate the levels of cardio-ankle vascular index (CAVI), global longitudinal strain (GLS), ventricular-arterial coupling (VAC), and high-sensitivity cardiac troponin I (hsTnI) in SLE patients and to explore their relationship with clinical parameters. Methods: This cross-sectional study enrolled 82 SLE patients without evident cardiac or kidney impairment and 41 age- and sex-matched healthy controls. We comparatively evaluated CAVI, GLS, VAC, and hsTnI between SLE patients and controls, and we assessed their association among SLE patients with disease activity based on the SELENA-SLEDAI Activity Index. Multivariate regression analysis was performed to identify independent predictors of CAVI and hsTnI within the SLE cohort. Results: In comparison to healthy controls, SLE patients presented with significantly higher CAVI, GLS, and hsTnI levels, while VAC was significantly reduced (p < 0.001). Furthermore, SLE patients with active disease (SELENA-SLEDAI ≥ 4) exhibited higher levels of CAVI and troponin than those with inactive disease (p < 0.001). SLEDAI was an independent predictor of CAVI, while VAC and SLEDAI were independent determinants of hsTnI in the SLE cohort. Conclusions: SLE patients displayed abnormal levels of CAVI, VAC, GLS, and troponin compared to healthy individuals. Our findings implicate the potential of those CV novel CVD risk factors to refine screening and therapeutic strategies for this specific population.
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Affiliation(s)
- Nikolaos P. E. Kadoglou
- Medical School, University of Cyprus, 215/6 Old road Lefkosias-Lemesou, Aglatzia CY 2029, Nicosia 1678, Cyprus; (A.D.); (E.G.); (K.P.)
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7
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Fleischer S, Nash TR, Tamargo MA, Lock RI, Venturini G, Morsink M, Li V, Lamberti MJ, Graney PL, Liberman M, Kim Y, Zhuang RZ, Whitehead J, Friedman RA, Soni RK, Seidman JG, Seidman CE, Geraldino-Pardilla L, Winchester R, Vunjak-Novakovic G. An engineered human cardiac tissue model reveals contributions of systemic lupus erythematosus autoantibodies to myocardial injury. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.07.583787. [PMID: 38559188 PMCID: PMC10979865 DOI: 10.1101/2024.03.07.583787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Systemic lupus erythematosus (SLE) is a highly heterogenous autoimmune disease that affects multiple organs, including the heart. The mechanisms by which myocardial injury develops in SLE, however, remain poorly understood. Here we engineered human cardiac tissues and cultured them with IgG fractions containing autoantibodies from SLE patients with and without myocardial involvement. We observed unique binding patterns of IgG from two patient subgroups: (i) patients with severe myocardial inflammation exhibited enhanced binding to apoptotic cells within cardiac tissues subjected to stress, and (ii) patients with systolic dysfunction exhibited enhanced binding to the surfaces of viable cardiomyocytes. Functional assays and RNA sequencing (RNA-seq) revealed that IgGs from patients with systolic dysfunction exerted direct effects on engineered tissues in the absence of immune cells, altering tissue cellular composition, respiration and calcium handling. Autoantibody target characterization by phage immunoprecipitation sequencing (PhIP-seq) confirmed distinctive IgG profiles between patient subgroups. By coupling IgG profiling with cell surface protein analyses, we identified four pathogenic autoantibody candidates that may directly alter the function of cells within the myocardium. Taken together, these observations provide insights into the cellular processes of myocardial injury in SLE that have the potential to improve patient risk stratification and inform the development of novel therapeutic strategies.
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Affiliation(s)
- Sharon Fleischer
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Trevor R Nash
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Manuel A Tamargo
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Roberta I Lock
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | | | - Margaretha Morsink
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Vanessa Li
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Morgan J Lamberti
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Pamela L Graney
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Martin Liberman
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Youngbin Kim
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Richard Z Zhuang
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Jaron Whitehead
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Richard A Friedman
- Biomedical Informatics Shared Resource, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Rajesh K Soni
- Proteomics and Macromolecular Crystallography Shared Resource, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | | | - Christine E Seidman
- Department of Genetics, Harvard Medical School, Boston, MA, USA
- Division of Cardiovascular Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | | | - Robert Winchester
- Department of Medicine, Columbia University, New York, NY, USA
- Columbia Center for Translational Immunology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Gordana Vunjak-Novakovic
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
- Department of Medicine, Columbia University, New York, NY, USA
- College of Dental Medicine, Columbia University, New York, NY, USA
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8
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Myhr KA, Zinglersen AH, Pecini R, Jacobsen S. Myocardial fibrosis associates with lupus anticoagulant in patients with systemic lupus erythematosus. Int J Cardiovasc Imaging 2024; 40:127-137. [PMID: 37814154 PMCID: PMC10774215 DOI: 10.1007/s10554-023-02970-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/24/2023] [Indexed: 10/11/2023]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that carries increased risk of cardiovascular disease; however, the underlying pathophysiological mechanisms remain poorly understood. We aimed to investigate the prevalence and degree of myocardial fibrosis in SLE patients and associated disease characteristics. Forty-nine SLE patients (89% female, mean age 52 ± 13 years, median disease duration 19 (11-25) years) and 79 sex-and age-matched healthy controls were included. CMR with T1 mapping was performed on SLE patients and healthy controls. Fifty-one SLE patients received gadolinium contrast for the evaluation of late gadolinium enhancement (LGE) and extra cellular volume (ECV). Multiple linear regression analyses were performed to investigate the association between markers of myocardial fibrosis on CMR (LGE, T1, ECV) and SLE-related variables [clinical disease activity, lupus nephritis, chronic kidney disease, anti-cardiolipin and/or anti-beta-2 glycoprotein I antibodies, and lupus anticoagulant (LAC)] with adjustment for traditional risk factors. T1 values were elevated in SLE patients compared to healthy controls (1031 ± 36 ms vs. 1019 ± 25 ms, p = 0.01). LGE was present in 20% of SLE patients who received gadolinium contrast. On multivariable analysis, LAC was associated with LGE in SLE patients (β = 3.87, p = 0.02). Neither T1 nor ECV associated with SLE disease characteristics; however, there was a trend towards an association between LAC and T1 (β = 16.9, p = 0.08). SLE patients displayed signs of myocardial fibrosis on CMR that were associated with the presence of LAC. These findings support the pathophysiological understanding of LAC as a mediator of microvascular and subsequent myocardial dysfunction.
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Affiliation(s)
- Katrine A Myhr
- Department of Cardiology, Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark.
| | - Amanda H Zinglersen
- Copenhagen Research Center for Autoimmune Connective Tissue Diseases, Center for Rheumatology and Spine Diseases, Rigshospitalet, Juliane Maries Vej 10, 2100, Copenhagen, Denmark.
| | - Redi Pecini
- Department of Cardiology, Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
| | - Søren Jacobsen
- Copenhagen Research Center for Autoimmune Connective Tissue Diseases, Center for Rheumatology and Spine Diseases, Rigshospitalet, Juliane Maries Vej 10, 2100, Copenhagen, Denmark.
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9
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Azzam M, Awad A, Abugharbyeh A, Kahaleh B. Myocarditis in connective tissue diseases: an often-overlooked clinical manifestation. Rheumatol Int 2023; 43:1983-1992. [PMID: 37587233 DOI: 10.1007/s00296-023-05428-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/08/2023] [Indexed: 08/18/2023]
Abstract
To discuss what is currently known about myocarditis in the context of major connective tissue diseases, including Systemic lupus erythematosus, Rheumatoid Arthritis, Sjogren, Dermato-myositis and Polymyositis, Systemic Sclerosis, and Mixed connective tissue disease. Variability exists between studies regarding the incidence of myocarditis in connective tissue diseases, which is hypothesized to be the result of its subclinical course in most cases. Extensive gaps of knowledge exist in the field of pathophysiology. Although endomyocardial biopsy remains to be the gold standard for diagnosis, the advancement in non-invasive modalities such as cardiac MRI, echocardiography, and nuclear medicine has allowed for earlier and more frequent detection of myocarditis. A lack of treatment guidelines was found across the different connective tissue diseases. Most of the literature available revolved around myocarditis in the context of Systemic lupus erythematosus. Numerous recent studies were published that contributed to advancements in diagnosis and treatment however, there remains a lack of diagnostic and treatment guidelines.
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Affiliation(s)
- Muayad Azzam
- Faculty of Medicine, The University of Jordan, Amman, 11942, Jordan.
| | - Amro Awad
- Faculty of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Aya Abugharbyeh
- Division of Rheumatology and Immunology, University of Toledo Medical Center, Toledo, USA
| | - Bashar Kahaleh
- Division of Rheumatology and Immunology, University of Toledo Medical Center, Toledo, USA
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10
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Feng X, Liu P, Liu X, Guo T, Li X, Yang H, Chen W, Wang Y, Zhang S. The Presence, Location, and Degree of Late Gadolinium Enhancement in Relation to Myocardial Dysfunction and Poor Prognosis in Patients with Systemic Lupus Erythematosus. J Cardiovasc Dev Dis 2023; 10:451. [PMID: 37998509 PMCID: PMC10672496 DOI: 10.3390/jcdd10110451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/19/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023] Open
Abstract
Patients with systemic lupus erythematosus (SLE) typically develop myocardial fibrosis. No studies have investigated the clinical significance of the presence, location, and degree of fibrosis in SLE patients. Seventy-four SLE patients were included. Thirty-seven non-autoimmune disease patients and thirty-seven healthy individuals were included as controls. Myocardial fibrosis was evaluated at cardiac magnetic resonance via a qualitative and quantitative assessment of late gadolinium enhancement (LGE). Myocardial function was measured via speckle-tracking echocardiography. All patients were followed up for the occurrence of major adverse cardiac events (MACE). The presence, locations, and degrees of LGE disturbed regional and global myocardial function. The presence of LGE, left ventricular free-wall LGE (LVFW LGE), and severe LGE were all independent predictors of MACE in SLE patients [LGE presence HR: 3.746 (1.434-9.79), p = 0.007; LVFW LGE HR: 2.395 (1.023-5.606), p = 0.044; severe LGE HR: 3.739 (1.241-11.266), p = 0.019]. LGE combined with SLE-related organ damage identified patients at high risk of MACE (p < 0.001). In conclusion, the presence, degree, and location of LGE were associated with myocardial dysfunction. The presence, location, and degree of LGE had the potential to independently predict poor prognosis and improve risk stratification in SLE patients.
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Affiliation(s)
- Xiaojin Feng
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (X.F.); (X.L.); (T.G.); (X.L.); (W.C.)
| | - Peijun Liu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China;
| | - Xiaohang Liu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (X.F.); (X.L.); (T.G.); (X.L.); (W.C.)
| | - Tianchen Guo
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (X.F.); (X.L.); (T.G.); (X.L.); (W.C.)
| | - Xinhao Li
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (X.F.); (X.L.); (T.G.); (X.L.); (W.C.)
| | - Huaxia Yang
- Department of Rheumatology and Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China;
| | - Wei Chen
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (X.F.); (X.L.); (T.G.); (X.L.); (W.C.)
| | - Yining Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China;
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (X.F.); (X.L.); (T.G.); (X.L.); (W.C.)
- State Key Laboratory of Complex, Severe, and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
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11
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Puntmann VO, Shchendrygina A, Bolanos CR, Madjiguène Ka M, Valbuena S, Rolf A, Escher F, Nagel E. Cardiac Involvement Due to COVID-19: Insights from Imaging and Histopathology. Eur Cardiol 2023; 18:e58. [PMID: 37942208 PMCID: PMC10628999 DOI: 10.15420/ecr.2023.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 07/04/2023] [Indexed: 11/10/2023] Open
Abstract
Lingering cardiac symptoms are increasingly recognised complications of severe acute respiratory syndrome coronavirus 2 infection, now referred to as post-acute cardiovascular sequelae of COVID-19 (PASC). In the acute phase, cardiac injury is driven by cytokine release and stems from ischaemic and thrombotic complications, resulting in myocardial necrosis. Patients with pre-existing cardiac conditions are particularly vulnerable. Myocarditis due to a direct viral infection is rare. Chronic symptoms relate to either worsening of pre-existing heart disease (PASC - cardiovascular disease) or delayed chronic inflammatory condition due to heterogenous immune dysregulation (PASC - cardiovascular syndrome), the latter affecting a broad segment of previously well people. Both PASC presentations are associated with increased cardiovascular risk, long-term disability and reduced quality of life. The recognition and management of PASC in clinical settings remains a considerable challenge. Sensitive diagnostic methods are needed to detect subtler inflammatory changes that underlie the persistent symptoms in PASC - cardiovascular syndrome, alongside considerable clinical experience in inflammatory cardiac conditions.
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Affiliation(s)
- Valentina O Puntmann
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt Frankfurt am Main, Germany
| | - Anastasia Shchendrygina
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt Frankfurt am Main, Germany
| | - Carlos Rodriguez Bolanos
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt Frankfurt am Main, Germany
| | - Mame Madjiguène Ka
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt Frankfurt am Main, Germany
| | - Silvia Valbuena
- Department of Cardiology, University Hospital La Paz Madrid, Spain
| | - Andreas Rolf
- Department of Cardiology, Campus Kerckhoff of Justus-Liebig-University Giessen Bad Nauheim, Germany
| | - Felicitas Escher
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH Berlin, Germany
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt Frankfurt am Main, Germany
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12
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Blachut D, Przywara-Chowaniec B, Tomasik A, Kukulski T, Morawiec B. Update of Potential Biomarkers in Risk Prediction and Monitoring of Atherosclerosis in Systemic Lupus Erythematosus to Prevent Cardiovascular Disease. Biomedicines 2023; 11:2814. [PMID: 37893187 PMCID: PMC10604001 DOI: 10.3390/biomedicines11102814] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Systemic lupus erythematosus is a chronic connective tissue disease associated with an increased risk of premature atherosclerosis. It is estimated that approximately 10% of SLE patients develop significant atherosclerosis each year, which is responsible for premature cardiovascular disease that is largely asymptomatic. This review summarizes the most recent reports from the past few years on biomarkers of atherosclerosis in SLE, mainly focusing on immune markers. Persistent chronic inflammation of the vascular wall is an important cause of cardiovascular disease (CVD) events related to endothelial dysfunction, cell proliferation, impaired production and function of nitric oxide and microangiopathic changes. Studies on pathogenic immune mediators involved in atherosclerosis will be crucial research avenues for preventing CVD.
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Affiliation(s)
- Dominika Blachut
- 2nd Department of Cardiology, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland
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13
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Luo S, Dou WQ, Schoepf UJ, Varga-Szemes A, Pridgen WT, Zhang LJ. Cardiovascular magnetic resonance imaging in myocardial involvement of systemic lupus erythematosus. Trends Cardiovasc Med 2023; 33:346-354. [PMID: 35150849 DOI: 10.1016/j.tcm.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/18/2022] [Accepted: 02/02/2022] [Indexed: 10/19/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that primarily affects young women. Myocardial involvement in SLE frequently occurs and it is rather challenging to make the diagnosis in current clinical settings, mainly due to the extensive clinical presentation of signs and symptoms. As a noninvasive imaging reference in diagnosing cardiomyopathy and myocarditis, cardiovascular magnetic resonance (CMR) imaging can provide new insight into myocardial abnormalities including inflammation, fibrosis, and microcirculation. Therefore, the main aim of this work was to systematically review the pathology, clinical features, and diagnosis, while illustrating the clinical role of CMR on myocardial involvement of SLE.
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Affiliation(s)
- Song Luo
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | | | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Wanya T Pridgen
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Long Jiang Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China.
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14
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Sabio JM, Garcia-de Los Ríos C, Medina-Casado M, Del Mar Del Águila-García M, Cáliz-Cáliz R, Díaz-Chamorro A. High-sensitivity cardiac troponin I is a biomarker for increased arterial stiffness in systemic lupus erythematous women with normal kidney function. Rheumatol Int 2023; 43:253-263. [PMID: 36094601 DOI: 10.1007/s00296-022-05204-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/29/2022] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease (CVD) is a main cause of death in patients with systemic lupus erythematous (SLE). Algorithms for cardiovascular risk stratification in general population underestimate the risk for CVD in SLE. Our study aimed to determine whether serum high-sensitivity cardiac troponin I (hs-cTnI) might help to identify SLE patients with subclinical atherosclerosis. Arterial stiffness was assessed measuring the carotid-femoral pulse wave velocity (PWV) in 68 SLE women with a normal or almost normal kidney function and in 71 controls of similar characteristics. None of the participants had a history of an overt CVD. Serum hs-cTnI level was measured using the chemiluminescence method. Factors associated with an increased PWV (iPWV) were identified and multivariate analysis was performed. When detectable, patients tended to have had higher hs-cTnI levels than controls [2.9 (2.3-4.0) vs 2.4 (2.2-4.1); p = 0.098] and were more likely to have detectable hs-cTnI [50% vs 28%, odds ratio (OR) 7.0; 95% confidence interval (CI) 0.008-0.013]. Also, patients with iPWV were more likely to have detectable hs-cTnI than those with normal PWV (OR 6.4; 95% CI 0.019-0.026). In the multivariate analysis, the age at SLE diagnosis (OR 1.24; 95% CI 1.04-1.48), systolic blood pressure (OR 1.28; 95% CI 1.10-1.48) and detectable hs-cTnI level (OR 2.04; 95% CI 1.18-3.50) were independently associated with an iPWV. The negative predictive value of having an iPWV with undetectable hs-cTnI levels was 88%. Hs-cTnI may be a useful biomarker for the identification of SLE patients with iPWV as a surrogated marker of subclinical atherosclerosis. Specifically targeted prospective studies are needed to confirm this hypothesis.
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Affiliation(s)
- J M Sabio
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de Las Nieves University Hospital, Granada, Spain
| | - Carlos Garcia-de Los Ríos
- Department of Internal Medicine, Virgen de Las Nieves University Hospital, 9th Floor, Avda. Fuerzas Armadas No. 2, 18012, Granada, Spain.
| | | | | | - Rafael Cáliz-Cáliz
- Department of Rheumatology, Virgen de Las Nieves University Hospital, Granada, Spain
| | - Antonio Díaz-Chamorro
- Department of Internal Medicine, Virgen de Las Nieves University Hospital, 9th Floor, Avda. Fuerzas Armadas No. 2, 18012, Granada, Spain
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15
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du Toit R, Karamchand S, Doubell AF, Reuter H, Herbst PG. Lupus myocarditis: review of current diagnostic modalities and their application in clinical practice. Rheumatology (Oxford) 2023; 62:523-534. [PMID: 35861382 DOI: 10.1093/rheumatology/keac409] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 02/04/2023] Open
Abstract
Lupus myocarditis (LM) is a potentially fatal manifestation of SLE, occurring in 5-10% of patients. Clinical manifestations may vary from an unexplained tachycardia to fulminant congestive cardiac failure (CCF). With no single clinical or imaging modality being diagnostic, a rational and practical approach to the patient presenting with possible LM is essential. Markers of myocyte injury (including troponin I and creatine kinase) may be unelevated and do not exclude a diagnosis of LM. Findings on ECG are non-specific but remain essential to exclude other causes of CCF such as an acute coronary syndrome or conduction disorders. Echocardiographic modalities including wall motion abnormalities and speckle tracking echocardiography may demonstrate regional and/or global left ventricular dysfunction and is more sensitive than conventional echocardiography, especially early in the course of LM. Cardiac magnetic resonance imaging (CMRI) is regarded as the non-invasive diagnostic modality of choice in myocarditis. While more sensitive and specific than echocardiography, CMRI has certain limitations in the context of SLE, including technical challenges in acutely unwell and uncooperative patients, contraindications to gadolinium use in the context of renal impairment (including lupus nephritis) and limited literature regarding the application of recommended diagnostic CMRI criteria in SLE. Both echocardiography as well as CMRI may detect subclinical myocardial dysfunction and/or injury of which the clinical significance remains uncertain. Considering these challenges, a combined decision-making approach by rheumatologists and cardiologists interpreting diagnostic test results within the clinical context of the patient is essential to ensure an accurate, early diagnosis of LM.
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Affiliation(s)
| | | | | | - Helmuth Reuter
- Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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16
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Early cardiac involvement detected by cardiac magnetic resonance feature tracking in idiopathic inflammatory myopathy with preserved ejection fraction. Int J Cardiovasc Imaging 2023; 39:183-194. [PMID: 36112253 DOI: 10.1007/s10554-022-02715-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 08/08/2022] [Indexed: 01/07/2023]
Abstract
Cardiac involvement is common in idiopathic inflammatory myopathy (IIM) but often subclinical. Cardiac magnetic resonance (CMR) is a promising tool in detecting cardiac involvement in patients with IIM. The aim of this study was to assess cardiac involvement in IIM patients by CMR feature tracking (CMR-FT). Thirty-seven IIM patients and 25 controls were enrolled in this retrospective study. The left ventricular (LV) functional parameters such as volume and ejection fraction were measured. Global and regional LV peak strain (PS) in radial, circumferential and longitudinal directions were derived from cine images. Left atrial (LA) volume, longitudinal strain and strain rate (SR) parameters and LA reservoir function, conduit function and booster pump function were assessed, respectively. IIM patients with preserved LVEF showed significantly reduced global and regional LV PS in longitudinal direction (all p < 0.05). Compared with controls, LA reservoir and conduit function were significantly impaired in IIM patients (all p < 0.05). The global LV longitudinal PS, LAVpre-ac and SRe were independent predictors of IIM. By Pearson's correlation analysis, the LV global radial, circumferential and longitudinal PS were all correlated to LVEF in IIM patients (r = 0.526, p < 0.001 vs. r = - 0.514, p < 0.001 vs. r = - 0.288, p = 0.023). CMR-FT based LV and LA deformation performance could early detect cardiac involvement in IIM patients with preserved LVEF.
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17
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Characterization of COVID-19-Related Lung Involvement in Patients Undergoing Magnetic Resonance T1 and T2 Mapping Imaging: A Pilot Study. J Imaging 2022; 8:jimaging8120314. [PMID: 36547479 PMCID: PMC9781162 DOI: 10.3390/jimaging8120314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/12/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022] Open
Abstract
Tissue characterization by mapping techniques is a recent magnetic resonance imaging (MRI) tool that could aid the tissue characterization of lung parenchyma in coronavirus disease-2019 (COVID-19). The aim of the present study was to compare lung MRI findings, including T1 and T2 mapping, in a group of n = 11 patients with COVID-19 pneumonia who underwent a scheduled cardiac MRI, and a cohort of healthy controls. MRI scout images were used to identify affected and remote lung regions within the patients’ cohort and appropriate regions of interest (ROIs) were drawn accordingly. Both lung native T1 and T2 values were significantly higher in the affected areas of patients with COVID-19 as compared to the controls (1375 ms vs. 1201 ms, p = 0.016 and 70 ms vs. 30 ms, p < 0.001, respectively), whereas no significant differences were detected between the remote lung parenchyma of the COVID-19 patients and the controls (both p > 0.05). When a larger ROI was identified, comprising the whole lung parenchyma within the image irrespective of the affected and remote areas, the COVID-19 patients still retained higher native T1 (1278 ms vs. 1149 ms, p = 0.003) and T2 values (38 ms vs. 34 ms, p = 0.04). According to the receiver operator characteristics curves, the T2 value of the affected region retained the higher accuracy for the differentiation of the COVID-19 patients against the controls (area under the curve 0.934, 95% confidence interval 0.826−0.999). These findings, possibly driven by the ability of MRI tissue mapping to detect ongoing inflammation in the lungs of patients with COVID-19, suggest that T1 and T2 mapping of the lung is a feasible approach in this clinical scenario.
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18
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Puntmann VO, Martin S, Shchendrygina A, Hoffmann J, Ka MM, Giokoglu E, Vanchin B, Holm N, Karyou A, Laux GS, Arendt C, De Leuw P, Zacharowski K, Khodamoradi Y, Vehreschild MJGT, Rohde G, Zeiher AM, Vogl TJ, Schwenke C, Nagel E. Long-term cardiac pathology in individuals with mild initial COVID-19 illness. Nat Med 2022; 28:2117-2123. [PMID: 36064600 PMCID: PMC9556300 DOI: 10.1038/s41591-022-02000-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 08/08/2022] [Indexed: 01/03/2023]
Abstract
Cardiac symptoms are increasingly recognized as late complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in previously well individuals with mild initial illness, but the underlying pathophysiology leading to long-term cardiac symptoms remains unclear. In this study, we conducted serial cardiac assessments in a selected population of individuals with Coronavirus Disease 2019 (COVID-19) with no previous cardiac disease or notable comorbidities by measuring blood biomarkers of heart injury or dysfunction and by performing magnetic resonance imaging. Baseline measurements from 346 individuals with COVID-19 (52% females) were obtained at a median of 109 days (interquartile range (IQR), 77-177 days) after infection, when 73% of participants reported cardiac symptoms, such as exertional dyspnea (62%), palpitations (28%), atypical chest pain (27%) and syncope (3%). Symptomatic individuals had higher heart rates and higher imaging values or contrast agent accumulation, denoting inflammatory cardiac involvement, compared to asymptomatic individuals. Structural heart disease or high levels of biomarkers of cardiac injury or dysfunction were rare in symptomatic individuals. At follow-up (329 days (IQR, 274-383 days) after infection), 57% of participants had persistent cardiac symptoms. Diffuse myocardial edema was more pronounced in participants who remained symptomatic at follow-up as compared to those who improved. Female gender and diffuse myocardial involvement on baseline imaging independently predicted the presence of cardiac symptoms at follow-up. Ongoing inflammatory cardiac involvement may, at least in part, explain the lingering cardiac symptoms in previously well individuals with mild initial COVID-19 illness.
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Affiliation(s)
- Valentina O Puntmann
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany.
| | - Simon Martin
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Anastasia Shchendrygina
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Jedrzej Hoffmann
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany.,Institute of Cardiovascular Regeneration, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Mame Madjiguène Ka
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Eleni Giokoglu
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Byambasuren Vanchin
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Niels Holm
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Argyro Karyou
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Gerald S Laux
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christophe Arendt
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Kai Zacharowski
- Department of Anesthesiology, Intensive Care Medicine & Pain Therapy; Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Yascha Khodamoradi
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Maria J G T Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Gernot Rohde
- Department of Internal Medicine, Respiratory Medicine, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Andreas M Zeiher
- Institute of Cardiovascular Regeneration, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
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19
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Mavrogeni S, Pepe A, Nijveldt R, Ntusi N, Sierra-Galan LM, Bratis K, Wei J, Mukherjee M, Markousis-Mavrogenis G, Gargani L, Sade LE, Ajmone-Marsan N, Seferovic P, Donal E, Nurmohamed M, Cerinic MM, Sfikakis P, Kitas G, Schwitter J, Lima JAC, Dawson D, Dweck M, Haugaa KH, Keenan N, Moon J, Stankovic I, Donal E, Cosyns B. Cardiovascular magnetic resonance in autoimmune rheumatic diseases: a clinical consensus document by the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2022; 23:e308-e322. [PMID: 35808990 DOI: 10.1093/ehjci/jeac134] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 11/12/2022] Open
Abstract
Autoimmune rheumatic diseases (ARDs) involve multiple organs including the heart and vasculature. Despite novel treatments, patients with ARDs still experience a reduced life expectancy, partly caused by the higher prevalence of cardiovascular disease (CVD). This includes CV inflammation, rhythm disturbances, perfusion abnormalities (ischaemia/infarction), dysregulation of vasoreactivity, myocardial fibrosis, coagulation abnormalities, pulmonary hypertension, valvular disease, and side-effects of immunomodulatory therapy. Currently, the evaluation of CV involvement in patients with ARDs is based on the assessment of cardiac symptoms, coupled with electrocardiography, blood testing, and echocardiography. However, CVD may not become overt until late in the course of the disease, thus potentially limiting the therapeutic window for intervention. More recently, cardiovascular magnetic resonance (CMR) has allowed for the early identification of pathophysiologic structural/functional alterations that take place before the onset of clinically overt CVD. CMR allows for detailed evaluation of biventricular function together with tissue characterization of vessels/myocardium in the same examination, yielding a reliable assessment of disease activity that might not be mirrored by blood biomarkers and other imaging modalities. Therefore, CMR provides diagnostic information that enables timely clinical decision-making and facilitates the tailoring of treatment to individual patients. Here we review the role of CMR in the early and accurate diagnosis of CVD in patients with ARDs compared with other non-invasive imaging modalities. Furthermore, we present a consensus-based decision algorithm for when a CMR study could be considered in patients with ARDs, together with a standardized study protocol. Lastly, we discuss the clinical implications of findings from a CMR examination.
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Affiliation(s)
- S Mavrogeni
- Onassis Cardiac Surgery Center, Leof. Andrea Siggrou 356, Kallithea 176 74, Greece.,Exercise Physiology and Sport Medicine Clinic, Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 115 27 Athens, Greece
| | - A Pepe
- Institute of Radiology, Department of Medicine, University of Padua, 35122 Padua, Italy
| | - R Nijveldt
- Department of Cardiology, Radboud University Medical Center, 6525 GA, Nijmegen, the Netherlands
| | - N Ntusi
- University of Cape Town & Groote Schuur Hospital, City of Cape Town, 7700 Western Cape, South Africa
| | - L M Sierra-Galan
- Department of Cardiology, American British Cowdray Medical Center, 05330 Mexico City, Mexico
| | - K Bratis
- Department of Cardiology, Manchester Royal Infirmary, Manchester M13 9WL, UK
| | - J Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA 90048, USA.,Preventive and Rehabilitative Cardiac Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA 90048, USA
| | - M Mukherjee
- Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | | | - L Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - L E Sade
- University of Pittsburgh, University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA 15260, USA.,Department of Cardiology, Baskent University, 06790 Ankara, Turkey
| | - N Ajmone-Marsan
- Department of Cardiology, Leiden University Medical Center, 2311 EZ Leiden, the Netherlands
| | - P Seferovic
- Department of Cardiology, Belgrade University, 11000 Belgrade, Serbia
| | - E Donal
- Université RENNES-1, CHU, 35000 Rennes, France
| | - M Nurmohamed
- Amsterdam Rheumatology Immunology Center, Amsterdam University Medical Centers, 1105 AZ, Amsterdam, the Netherlands
| | - M Matucci Cerinic
- Experimental and Clinical Medicine, Division of Internal Medicine and Rheumatology, Azienda Ospedaliera Universitaria Careggi, University of Florence, 50121 Florence, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS, San Raffaele Hospital, 20132 Milan, Italy
| | - P Sfikakis
- First Department of Propeudeutic and Internal medicine, Laikon Hospital, Athens University Medical School, 115 27 Athens, Greece
| | - G Kitas
- Arthritis Research UK Epidemiology Unit, Manchester University, Manchester M13 9PL, UK
| | - J Schwitter
- Lausanne University Hospital, CHUV, CH-1011 Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, 1015 UniL, Switzerland.,Director CMR Center of the University Hospital Lausanne, CHUV, CH-1011 Lausanne, Switzerland
| | - J A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD 21287, USA
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20
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Subclinical Myocardial Fibrosis in Systemic Lupus Erythematosus as Assessed by Pulse-Cancellation Echocardiography: A Pilot Study. J Clin Med 2022; 11:jcm11164788. [PMID: 36013027 PMCID: PMC9410017 DOI: 10.3390/jcm11164788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to examine whether scar imaging echocardiography with ultrasound multi-pulse scheme (eSCAR) can detect subclinical myocardial involvement in systemic lupus erythematosus (SLE). We consecutively recruited SLE patients and controls matched for age, sex, and cardiovascular risk factors. Participants with cardiac symptoms or a prior history of heart disease were excluded. All participants underwent eSCAR and speckle tracking echocardiography (STE) with global longitudinal strain (GLS) assessment. SLE patients were assessed for disease activity and were followed up for 12 months. Myocardial scars by eSCAR were observed in 19% of SLE patients, almost exclusively localized at the inferoseptal myocardial segments, and in none of the controls. GLS was significantly lower in most myocardial segments of SLE patients compared with the controls, especially in the inferoseptal segments. eSCAR-positive SLE patients received a higher cumulative and current dose of prednisone, and had significantly higher levels of anti-dsDNA antibodies (p = 0.037). eSCAR-positive patients were at higher risk of having SLE flares over follow-up (hazard ratio: 4.91; 95% CI 1.43–16.83; p = 0.0001). We identified inferoseptal myocardial scars by eSCAR in about one-fifth of SLE patients. Subclinical myocardial involvement was associated with glucocorticoid use and anti-dsDNA antibodies.
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21
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O'Brien AT, Gil KE, Varghese J, Simonetti OP, Zareba KM. T2 mapping in myocardial disease: a comprehensive review. J Cardiovasc Magn Reson 2022; 24:33. [PMID: 35659266 PMCID: PMC9167641 DOI: 10.1186/s12968-022-00866-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 04/27/2022] [Indexed: 12/20/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) is considered the gold standard imaging modality for myocardial tissue characterization. Elevated transverse relaxation time (T2) is specific for increased myocardial water content, increased free water, and is used as an index of myocardial edema. The strengths of quantitative T2 mapping lie in the accurate characterization of myocardial edema, and the early detection of reversible myocardial disease without the use of contrast agents or ionizing radiation. Quantitative T2 mapping overcomes the limitations of T2-weighted imaging for reliable assessment of diffuse myocardial edema and can be used to diagnose, stage, and monitor myocardial injury. Strong evidence supports the clinical use of T2 mapping in acute myocardial infarction, myocarditis, heart transplant rejection, and dilated cardiomyopathy. Accumulating data support the utility of T2 mapping for the assessment of other cardiomyopathies, rheumatologic conditions with cardiac involvement, and monitoring for cancer therapy-related cardiac injury. Importantly, elevated T2 relaxation time may be the first sign of myocardial injury in many diseases and oftentimes precedes symptoms, changes in ejection fraction, and irreversible myocardial remodeling. This comprehensive review discusses the technical considerations and clinical roles of myocardial T2 mapping with an emphasis on expanding the impact of this unique, noninvasive tissue parameter.
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Affiliation(s)
- Aaron T O'Brien
- Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio, USA
| | - Katarzyna E Gil
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Juliet Varghese
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Orlando P Simonetti
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
- Department of Radiology, The Ohio State University, Columbus, Ohio, USA
| | - Karolina M Zareba
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA.
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22
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Markousis-Mavrogenis G, Bacopoulou F, Mavragani C, Voulgari P, Kolovou G, Kitas GD, Chrousos GP, Mavrogeni SI. Coronary microvascular disease: The "Meeting Point" of Cardiology, Rheumatology and Endocrinology. Eur J Clin Invest 2022; 52:e13737. [PMID: 34939183 DOI: 10.1111/eci.13737] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Exertional chest pain/dyspnea or chest pain at rest are the main symptoms of coronary artery disease (CAD), which are traditionally attributed to insufficiency of the epicardial coronary arteries. However, 2/3 of women and 1/3 of men with angina and 10% of patients with acute myocardial infarction have no evidence of epicardial coronary artery stenosis in X-ray coronary angiography. In these cases, coronary microvascular disease (CMD) is the main causative factor. AIMS To present the pathophysiology of CMD in Cardiology, Rheumatology and Endocrinology. MATERIALS-METHODS The pathophysiology of CMD in Cardiology, Rheumatology and Endocrinology was evaluated. It includes impaired microvascular vasodilatation, which leads to inability of the organism to deal with myocardial oxygen needs and, hence, development of ischemic pain. CMD, observed in inflammatory autoimmune rheumatic and endocrine/metabolic disorders, brings together Cardiology, Rheumatology and Endocrinology. Causative factors include persistent systemic inflammation and endocrine/metabolic abnormalities influencing directly the coronary microvasculature. In the past, the evaluation of microcirculation was feasible only with the use of invasive techniques, such as coronary flow reserve assessment. Currently, the application of advanced imaging modalities, such as cardiovascular magnetic resonance (CMR), can evaluate CMD non-invasively and without ionizing radiation. RESULTS CMD may present with a variety of symptoms with 1/3 to 2/3 of them expressed as typical chest pain in effort, more commonly found in women during menopause than in men. Atypical presentation includes chest pain at rest or exertional dyspnea,but post exercise symptoms are not uncommon. The treatment with nitrates is less effective in CMD, because their vasodilator action in coronary micro-circulation is less pronounced than in the epicardial coronary arteries. DISCUSSION Although both classic and new medications have been used in the treatment of CMD, there are still many questions regarding both the pathophysiology and the treatment of this disorder. The potential effects of anti-rheumatic and endocrine medications on the evolution of CMD need further evaluation. CONCLUSION CMD is a multifactorial disease leading to myocardial ischemia/fibrosis alone or in combination with epicardial coronary artery disease. Endothelial dysfunction/vasospasm, systemic inflammation, and/or neuroendocrine activation may act as causative factors and bring Cardiology, Rheumatology and Endocrinology together. Currently, the application of advanced imaging modalities, and specifically CMR, allows reliable assessment of the extent and severity of CMD. These measurements should not be limited to "pure cardiac patients", as it is known that CMD affects the majority of patients with autoimmune rheumatic and endocrine/metabolic disorders.
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Affiliation(s)
| | - Flora Bacopoulou
- University Research Institute of Maternal and Child Health and Precision Medicine, UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Clio Mavragani
- Pathophysiology Department, University of Athens, Athens, Greece
| | | | - Genovefa Kolovou
- Onassis Cardiac Surgery Hospital, Athens, Greece.,Epidemiology Department, University of Manchester, Manchester, UK
| | - George D Kitas
- Epidemiology Department, University of Manchester, Manchester, UK
| | - George P Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
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23
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Arcari L, Tini G, Camastra G, Ciolina F, De Santis D, Russo D, Caruso D, Danti M, Cacciotti L. Cardiac Magnetic Resonance Imaging in Immune Check-Point Inhibitor Myocarditis: A Systematic Review. J Imaging 2022; 8:jimaging8040099. [PMID: 35448226 PMCID: PMC9027245 DOI: 10.3390/jimaging8040099] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 12/02/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) are a family of anticancer drugs in which the immune response elicited against the tumor may involve other organs, including the heart. Cardiac magnetic resonance (CMR) imaging is increasingly used in the diagnostic work-up of myocardial inflammation; recently, several studies investigated the use of CMR in patients with ICI-myocarditis (ICI-M). The aim of the present systematic review is to summarize the available evidence on CMR findings in ICI-M. We searched electronic databases for relevant publications; after screening, six studies were selected, including 166 patients from five cohorts, and further 86 patients from a sub-analysis that were targeted for a tissue mapping assessment. CMR revealed mostly preserved left ventricular ejection fraction; edema prevalence ranged from 9% to 60%; late gadolinium enhancement (LGE) prevalence ranged from 23% to 83%. T1 and T2 mapping assessment were performed in 108 and 104 patients, respectively. When available, the comparison of CMR with endomyocardial biopsy revealed partial agreement between techniques and was higher for native T1 mapping amongst imaging biomarkers. The prognostic assessment was inconsistently assessed; CMR variables independently associated with the outcome included decreasing LVEF and increasing native T1. In conclusion, CMR findings in ICI-M include myocardial dysfunction, edema and fibrosis, though less evident than in more classic forms of myocarditis; native T1 mapping retained the higher concordance with EMB and significant prognostic value.
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Affiliation(s)
- Luca Arcari
- Cardiology Unit, Madre Giuseppina Vannini Hospital, 00177 Rome, Italy; (G.C.); (L.C.)
- Correspondence: ; Tel.: +39-0624291416
| | - Giacomo Tini
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza-University of Rome, 00100 Rome, Italy; (G.T.); (D.R.)
| | - Giovanni Camastra
- Cardiology Unit, Madre Giuseppina Vannini Hospital, 00177 Rome, Italy; (G.C.); (L.C.)
| | - Federica Ciolina
- Radiology Unit, Madre Giuseppina Vannini Hospital, 00177 Rome, Italy; (F.C.); (M.D.)
| | - Domenico De Santis
- Radiology Unit, Department of Medical Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, Sapienza-University of Rome, 00100 Rome, Italy; (D.D.S.); (D.C.)
| | - Domitilla Russo
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza-University of Rome, 00100 Rome, Italy; (G.T.); (D.R.)
| | - Damiano Caruso
- Radiology Unit, Department of Medical Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, Sapienza-University of Rome, 00100 Rome, Italy; (D.D.S.); (D.C.)
| | - Massimiliano Danti
- Radiology Unit, Madre Giuseppina Vannini Hospital, 00177 Rome, Italy; (F.C.); (M.D.)
| | - Luca Cacciotti
- Cardiology Unit, Madre Giuseppina Vannini Hospital, 00177 Rome, Italy; (G.C.); (L.C.)
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Colaco K, Lee KA, Akhtari S, Winer R, Welsh P, Sattar N, McInnes IB, Chandran V, Harvey P, Cook RJ, Gladman DD, Piguet V, Eder L. Association of Cardiac Biomarkers With Cardiovascular Outcomes in Patients With Psoriatic Arthritis and Psoriasis: A Longitudinal Cohort Study. Arthritis Rheumatol 2022; 74:1184-1192. [PMID: 35261189 PMCID: PMC9545279 DOI: 10.1002/art.42079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/08/2021] [Accepted: 01/25/2022] [Indexed: 11/20/2022]
Abstract
Objective In patients with psoriatic disease (PsD), we determined whether cardiac troponin I (cTnI) and N‐terminal pro–brain natriuretic peptide (NT‐proBNP) were associated with carotid plaque burden and the development of cardiovascular events independent of the Framingham Risk Score (FRS). Methods Among 1,000 patients with PsD, carotid total plaque area (TPA) was measured in 358 participants at baseline. Cardiac troponin I and NT‐proBNP were measured using automated clinical assays. The association between cardiac biomarkers and carotid atherosclerosis was assessed by multivariable regression after adjusting for cardiovascular risk factors. Improvement in the prediction of cardiovascular events beyond the FRS was tested using measures of risk discrimination and reclassification. Results In univariate analyses, cTnI (β coefficient 0.52 [95% confidence interval (95% CI) 0.3, 0.74], P < 0.001) and NT‐proBNP (β coefficient 0.24 [95% CI 0.1, 0.39], P < 0.001) were associated with TPA. After adjusting for cardiovascular risk factors, the association remained statistically significant for cTnI (adjusted β coefficient 0.21 [95% CI 0, 0.41], P = 0.047) but not for NT‐proBNP (P = 0.21). Among the 1,000 patients with PsD assessed for cardiovascular risk prediction, 64 patients had incident cardiovascular events. When comparing a base model (with the FRS alone) to expanded models (with the FRS plus cardiac biomarkers), there was no improvement in predictive performance. Conclusion In patients with PsD, cTnI may reflect the burden of atherosclerosis, independent of traditional cardiovascular risk factors. Cardiac troponin I and NT‐proBNP are associated with incident cardiovascular events independent of the FRS, but further study of their role in cardiovascular risk stratification is warranted.
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Affiliation(s)
- Keith Colaco
- Women's College Hospital, University of Toronto, and University Health Network, Toronto, Ontario, Canada
| | - Ker-Ai Lee
- University of Waterloo, Waterloo, Ontario, Canada
| | - Shadi Akhtari
- Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Raz Winer
- Rambam Health Care Campus, Haifa, Israel
| | | | | | | | - Vinod Chandran
- University of Toronto and University Health Network Toronto, Ontario, Canada
| | - Paula Harvey
- Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | - Dafna D Gladman
- University of Toronto and University Health Network Toronto, Ontario, Canada
| | - Vincent Piguet
- Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Lihi Eder
- Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
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25
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Feng J, Zhai Z, Wang Z, Huang L, Dong S, Liu K, Shi W, Lu G, Qin W. Speckle tracking imaging combined with myocardial comprehensive index to evaluate left ventricular function changes in patients with systemic lupus erythematosus. Echocardiography 2021; 38:1632-1640. [PMID: 34555198 DOI: 10.1111/echo.15189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/17/2021] [Accepted: 08/15/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate early changes in left ventricular systolic function in patients with systemic lupus erythematosus (SLE) using three-dimensional speckle tracking imaging (3D-STI). METHODS A total of 30 SLE patients and 30 healthy people (control group) were selected, the patients were further divided into subgroups according to their Safety of Estrogens in Lupus Erythematosus National Assessment version of the SLE Disease Activity Index (SELENA-SLEDAI) score: ≤ 12: mild-to-moderate group; > 12: severe group. All participants were examined using 3D-STI, the 3D-STI parameters were obtained. Receiver operating curves (ROC) were prepared for above parameters and analyzed to identify correlations among 3D-STI parameters and high sensitivity-TropT (hs-TropT). RESULTS Compared with the control group, the absolute values of left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), global circumferential strain (GCS), left ventricular twist angle (LVtw), torsion (Tor) and myocardial comprehensive index (MCI) decreased, left ventricular end diastolic mass (LV EDmass), left ventricular end systolic mass (LV ESmass) and peak strain dispersion (PSD) increased in the mild-to-moderate and the severe groups (P2 < 0.05, P3 < 0.05). There was statistically significant difference in terms of 3D-STI parameters between the mild-to-moderate group and the severe group (P1 < 0.05). The highest area under the ROC for MCI was 0.909, the highest sensitivity for MCI was 90.00%, and the highest specificity for Tor was 86.67%. Correlation analysis showed that there was a good correlation between the MCI and hs-TropT (r = - 0.677). CONCLUSION 3D-STI technology may help detect early changes in left ventricular systolic function in patients with SLE.
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Affiliation(s)
- Jia Feng
- Department of Ultrasonography, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Zijing Zhai
- Department of Ultrasonography, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Zhen Wang
- Department of Ultrasonography, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Lei Huang
- Department of Ultrasonography, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Shanshan Dong
- Department of Ultrasonography, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Kuichan Liu
- Department of Ultrasonography, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Wenrong Shi
- Department of Ultrasonography, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Guilin Lu
- Department of Ultrasonography, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Wenjuan Qin
- Department of Ultrasonography, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
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26
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Clinical and Immunological Biomarkers for Systemic Lupus Erythematosus. Biomolecules 2021; 11:biom11070928. [PMID: 34206696 PMCID: PMC8301935 DOI: 10.3390/biom11070928] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 12/16/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is characterized by immune system dysfunction and is clinically heterogeneous, exhibiting renal, dermatological, neuropsychiatric, and cardiovascular symptoms. Clinical and physiological assessment is usually inadequate for diagnosing and assessing pathophysiological processes in SLE. Clinical and immunological biomarkers could play a critical role in improving diagnosis, assessment, and ultimately, control of SLE. This article reviews clinical and immunological biomarkers that could diagnose and monitor disease activity in SLE, with and without organ-specific injury. In addition, novel SLE biomarkers that have been discovered through “omics” research are also reviewed.
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Arcari L, Engel J, Freiwald T, Zhou H, Zainal H, Gawor M, Buettner S, Geiger H, Hauser I, Nagel E, Puntmann VO. Cardiac biomarkers in chronic kidney disease are independently associated with myocardial edema and diffuse fibrosis by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2021; 23:71. [PMID: 34092229 PMCID: PMC8183054 DOI: 10.1186/s12968-021-00762-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 04/28/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND High sensitivity cardiac troponin T (hs-cTnT) and NT-pro-brain natriuretic peptide (NT-pro BNP) are often elevated in chronic kidney disease (CKD) and associated with both cardiovascular remodeling and outcome. Relationship between these biomarkers and quantitative imaging measures of myocardial fibrosis and edema by T1 and T2 mapping remains unknown. METHODS Consecutive patients with established CKD and estimated glomerular filtration rate (eGFR) < 59 ml/min/1.73 m2 (n = 276) were compared to age/sex matched patients with eGFR ≥ 60 ml/min/1.73 m2 (n = 242) and healthy controls (n = 38). Comprehensive cardiovascular magnetic resonance (CMR) with native T1 and T2 mapping, myocardial ischemia and scar imaging was performed with venous sampling immediately prior to CMR. RESULTS Patients with CKD showed significant cardiac remodeling in comparison with both healthy individuals and non-CKD patients, including a stepwise increase of native T1 and T2 (p < 0.001 between all CKD stages). Native T1 and T2 were the sole imaging markers independently associated with worsening CKD in patients [B = 0.125 (95% CI 0.022-0.235) and B = 0.272 (95% CI 0.164-0.374) with p = 0.019 and < 0.001 respectively]. At univariable analysis, both hs-cTnT and NT-pro BNP significantly correlated with native T1 and T2 in groups with eGFR 30-59 ml/min/1.73 m2 and eGFR < 29 ml/min/1.73 m2 groups, with associations being stronger at lower eGFR (NT-pro BNP (log transformed, lg10): native T1 r = 0.43 and r = 0.57, native T2 r = 0.39 and r = 0.48 respectively; log-transformed hs-cTnT(lg10): native T1 r = 0.23 and r = 0.43, native T2 r = 0.38 and r = 0.58 respectively, p < 0.001 for all, p < 0.05 for interaction). On multivariable analyses, we found independent associations of native T1 with NT-pro BNP [(B = 0.308 (95% CI 0.129-0.407), p < 0.001 and B = 0.334 (95% CI 0.154-0.660), p = 0.002 for eGFR 30-59 ml/min/1.73 m2 and eGFR < 29 ml/min/1.73 m2, respectively] and of T2 with hs-cTnT [B = 0.417 (95% CI 0.219-0.650), p < 0.001 for eGFR < 29 ml/min/1.73 m2]. CONCLUSIONS We demonstrate independent associations between cardiac biomarkers with imaging markers of interstitial expansion, which are CKD-group specific. Our findings indicate the role of diffuse non-ischemic tissue processes, including excess of myocardial fluid in addition to diffuse fibrosis in CKD-related adverse remodeling.
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Affiliation(s)
- Luca Arcari
- Institute of Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
- Cardiology Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Juergen Engel
- Department of Nephrology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Tilo Freiwald
- Department of Nephrology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Hui Zhou
- Institute of Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
- Department of Radiology, XiangYa Hospital, Central South University, Changsha, Hunan, China
| | - Hafisyatul Zainal
- Institute of Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
- Department of Cardiology, Universiti Teknologi MARA (UiTM), Sg. Buloh, Malaysia
| | - Monika Gawor
- Department of Cardiology, University Hospital Warsaw, Warsaw, Poland
| | - Stefan Buettner
- Department of Nephrology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Helmut Geiger
- Department of Nephrology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ingeborg Hauser
- Department of Nephrology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Eike Nagel
- Institute of Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Valentina O Puntmann
- Institute of Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany.
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de Leuw P, Arendt CT, Haberl AE, Froadinadl D, Kann G, Wolf T, Stephan C, Schuettfort G, Vasquez M, Arcari L, Zhou H, Zainal H, Gawor M, Vidalakis E, Kolentinis M, Albrecht MH, Escher F, Vogl TJ, Zeiher AM, Nagel E, Puntmann VO. Myocardial Fibrosis and Inflammation by CMR Predict Cardiovascular Outcome in People Living With HIV. JACC Cardiovasc Imaging 2021; 14:1548-1557. [PMID: 33865770 DOI: 10.1016/j.jcmg.2021.01.042] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/30/2020] [Accepted: 01/28/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The goal of this study was to examine prognostic relationships between cardiac imaging measures and cardiovascular outcome in people living with human immunodeficiency virus (HIV) (PLWH) on highly active antiretroviral therapy (HAART). BACKGROUND PLWH have a higher prevalence of cardiovascular disease and heart failure (HF) compared with the noninfected population. The pathophysiological drivers of myocardial dysfunction and worse cardiovascular outcome in HIV remain poorly understood. METHODS This prospective observational longitudinal study included consecutive PLWH on long-term HAART undergoing cardiac magnetic resonance (CMR) examination for assessment of myocardial volumes and function, T1 and T2 mapping, perfusion, and scar. Time-to-event analysis was performed from the index CMR examination to the first single event per patient. The primary endpoint was an adjudicated adverse cardiovascular event (cardiovascular mortality, nonfatal acute coronary syndrome, an appropriate device discharge, or a documented HF hospitalization). RESULTS A total of 156 participants (62% male; age [median, interquartile range]: 50 years [42 to 57 years]) were included. During a median follow-up of 13 months (9 to 19 months), 24 events were observed (4 HF deaths, 1 sudden cardiac death, 2 nonfatal acute myocardial infarction, 1 appropriate device discharge, and 16 HF hospitalizations). Patients with events had higher native T1 (median [interquartile range]: 1,149 ms [1,115 to 1,163 ms] vs. 1,110 ms [1,075 to 1,138 ms]); native T2 (40 ms [38 to 41 ms] vs. 37 ms [36 to 39 ms]); left ventricular (LV) mass index (65 g/m2 [49 to 77 g/m2] vs. 57 g/m2 [49 to 64 g/m2]), and N-terminal pro-B-type natriuretic peptide (109 pg/l [25 to 337 pg/l] vs. 48 pg/l [23 to 82 pg/l]) (all p < 0.05). In multivariable analyses, native T1 was independently predictive of adverse events (chi-square test, 15.9; p < 0.001; native T1 [10 ms] hazard ratio [95% confidence interval]: 1.20 [1.08 to 1.33]; p = 0.001), followed by a model that also included LV mass (chi-square test, 17.1; p < 0.001). Traditional cardiovascular risk scores were not predictive of the adverse events. CONCLUSIONS Our findings reveal important prognostic associations of diffuse myocardial fibrosis and LV remodeling in PLWH. These results may support development of personalized approaches to screening and early intervention to reduce the burden of HF in PLWH (International T1 Multicenter Outcome Study; NCT03749343).
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Affiliation(s)
- Philipp de Leuw
- HIV Center, Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany; Infektiologikum, Frankfurt am Main, Germany
| | - Christophe T Arendt
- Institute of Experimental and Translational Cardiac Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Annette E Haberl
- HIV Center, Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Daniel Froadinadl
- HIV Center, Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Gerrit Kann
- HIV Center, Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Timo Wolf
- HIV Center, Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christoph Stephan
- HIV Center, Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Gundolf Schuettfort
- HIV Center, Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Moises Vasquez
- Institute of Experimental and Translational Cardiac Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany; Cardiology Department, Enrique Baltodano Briceño Hospital, Liberia, Costa Rica
| | - Luca Arcari
- Institute of Experimental and Translational Cardiac Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Cardiology, School of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Hui Zhou
- Institute of Experimental and Translational Cardiac Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Radiology, XiangYa Hospital, Central South University, Changsha, Hunan, China
| | - Hafisyatul Zainal
- Institute of Experimental and Translational Cardiac Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Cardiology, Universiti Teknologi MARA (UiTM), Sg. Buloh, Malaysia
| | - Monika Gawor
- Institute of Experimental and Translational Cardiac Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Cardiology, University Hospital Warsaw, Warsaw, Poland
| | - Eleftherios Vidalakis
- Institute of Experimental and Translational Cardiac Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Michael Kolentinis
- Institute of Experimental and Translational Cardiac Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Moritz H Albrecht
- Institute of Experimental and Translational Cardiac Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Andreas M Zeiher
- Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Eike Nagel
- Institute of Experimental and Translational Cardiac Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Valentina O Puntmann
- Institute of Experimental and Translational Cardiac Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Cardiology, University Hospital Warsaw, Warsaw, Poland.
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Understanding Accelerated Atherosclerosis in Systemic Lupus Erythematosus: Toward Better Treatment and Prevention. Inflammation 2021; 44:1663-1682. [PMID: 33821395 DOI: 10.1007/s10753-021-01455-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/01/2021] [Accepted: 03/18/2021] [Indexed: 12/13/2022]
Abstract
Systemic lupus erythematosus (SLE) carries a significant risk of cardiovascular disease (CVD). The prevalence of premature CVD is especially noteworthy because it occurs in premenopausal women with SLE who would otherwise have very low rates of CVD. While traditional risk factors likely play a role in development of CVD in the setting of SLE, they do not fully explain the excess risk. The pathogenesis of CVD in SLE is not fully understood, but the inflammatory nature of SLE is believed to be a key factor in accelerating atherosclerosis. Systemic inflammation may lead to an abnormal lipid profile with elevated triglycerides, total cholesterol, and low-density lipoprotein cholesterol and dysfunctional high-density lipoprotein cholesterol. Additionally, the inflammatory milieu of SLE plasma promotes endothelial dysfunction and vascular injury, early steps in the progression of atherosclerotic CVD. Despite the overall headway that has been achieved in treating lupus, innovative therapeutics specifically targeting the progression of atherosclerosis within the lupus population are currently lacking. However, there have been advancements in the development of promising modalities for diagnosis of subclinical atherosclerosis and detection of high CVD risk patients. Due to the significant impact of CVD on morbidity and mortality, research addressing prevention and treatment of CVD in SLE needs to be prioritized. This review explores the intricate interplay of SLE-specific properties that contribute to atherosclerosis and CVD within this population, as well as screening methods and possible therapies.
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Zhou W, Abdelrahman KM, Dey AK, Reddy A, Uceda DE, Lateef SS, Elnabawi YA, Anzenberg P, Al Najafi M, Rodante JA, Keel A, Ortiz J, Teague HL, Erb-Alvarez J, Singh D, Joshi AA, Playford MP, Chen MY, Gelfand JM, Remaley AT, Bluemke DA, Mehta NN. Association Among Noncalcified Coronary Burden, Fractional Flow Reserve, and Myocardial Injury in Psoriasis. J Am Heart Assoc 2020; 9:e017417. [PMID: 33170072 PMCID: PMC7763703 DOI: 10.1161/jaha.119.017417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Myocardial infarction and premature death have been observed in patients with psoriasis. Although inflammation‐driven accelerated atherosclerosis has been proposed as a mechanism, the relationship between subclinical noncalcified coronary burden (NCB), functional coronary flow impairment, and myocardial injury is unclear. Methods and Results In an ongoing longitudinal cohort study, 202 consecutive patients with psoriasis (168 at 1 year) underwent coronary computed tomography angiography to identify coronary plaque, quantify NCB, and calculate coronary fractional flow reserve by computed tomography. Serum high‐sensitivity troponin‐T (hs‐cTn‐T) was measured using a fifth‐generation assay. Overall, patients were middle‐aged, predominantly male, and low cardiovascular risk. A higher than median NCB associated with a positive hs‐cTn‐T (fully adjusted model [odds ratio (OR), 1.72; 95% CI, 1.10–2.69, P=0.018]) at baseline. Additionally, patients with a higher than median baseline NCB had higher odds of positive hs‐cTn‐T at 1 year in fully adjusted analyses (adjusted OR, 2.36; 95% CI, 1.47–3.79, P<0.001). Higher NCB was associated with a higher frequency of fractional flow reserve by computed tomography ≤0.80 (36.11% versus 25.11%, Pearson χ2=6.84, P=0.009, unadjusted OR, 2.09; 95% CI, 1.36–3.22, P<0.001) and higher frequency of a positive hs‐cTn‐T (54.36% versus 27.54%, Pearson χ2=32.23, P<0.001) in adjusted models (OR, 2.63; 95% CI, 1.56–4.42, P<0.001). Conclusions NCB was associated with hs‐cTn‐T at baseline as well as at 1 year. Furthermore, patients with high NCB had higher prevalence of fractional flow reserve by computed tomography ≤0.80 and a >2‐ fold higher odds of positive hs‐cTn‐T. These findings underscore the importance of early vascular disease in driving myocardial injury, and support conduct of myocardial perfusion studies to better understand these findings.
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Affiliation(s)
- Wunan Zhou
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Khaled M Abdelrahman
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Amit K Dey
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Aarthi Reddy
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Domingo E Uceda
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Sundus S Lateef
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Youssef A Elnabawi
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Paula Anzenberg
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Mina Al Najafi
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Justin A Rodante
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Andrew Keel
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Jenis Ortiz
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Heather L Teague
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Julie Erb-Alvarez
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Dolly Singh
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Aditya A Joshi
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Martin P Playford
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Marcus Y Chen
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | | | - Alan T Remaley
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - David A Bluemke
- University of Wisconsin School of Medicine and Public Health Madison WI
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
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Puntmann VO, Carerj ML, Wieters I, Fahim M, Arendt C, Hoffmann J, Shchendrygina A, Escher F, Vasa-Nicotera M, Zeiher AM, Vehreschild M, Nagel E. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA Cardiol 2020; 5:1265-1273. [PMID: 32730619 PMCID: PMC7385689 DOI: 10.1001/jamacardio.2020.3557] [Citation(s) in RCA: 1390] [Impact Index Per Article: 347.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
IMPORTANCE Coronavirus disease 2019 (COVID-19) continues to cause considerable morbidity and mortality worldwide. Case reports of hospitalized patients suggest that COVID-19 prominently affects the cardiovascular system, but the overall impact remains unknown. OBJECTIVE To evaluate the presence of myocardial injury in unselected patients recently recovered from COVID-19 illness. DESIGN, SETTING, AND PARTICIPANTS In this prospective observational cohort study, 100 patients recently recovered from COVID-19 illness were identified from the University Hospital Frankfurt COVID-19 Registry between April and June 2020. EXPOSURE Recent recovery from severe acute respiratory syndrome coronavirus 2 infection, as determined by reverse transcription-polymerase chain reaction on swab test of the upper respiratory tract. MAIN OUTCOMES AND MEASURES Demographic characteristics, cardiac blood markers, and cardiovascular magnetic resonance (CMR) imaging were obtained. Comparisons were made with age-matched and sex-matched control groups of healthy volunteers (n = 50) and risk factor-matched patients (n = 57). RESULTS Of the 100 included patients, 53 (53%) were male, and the mean (SD) age was 49 (14) years. The median (IQR) time interval between COVID-19 diagnosis and CMR was 71 (64-92) days. Of the 100 patients recently recovered from COVID-19, 67 (67%) recovered at home, while 33 (33%) required hospitalization. At the time of CMR, high-sensitivity troponin T (hsTnT) was detectable (greater than 3 pg/mL) in 71 patients recently recovered from COVID-19 (71%) and significantly elevated (greater than 13.9 pg/mL) in 5 patients (5%). Compared with healthy controls and risk factor-matched controls, patients recently recovered from COVID-19 had lower left ventricular ejection fraction, higher left ventricle volumes, and raised native T1 and T2. A total of 78 patients recently recovered from COVID-19 (78%) had abnormal CMR findings, including raised myocardial native T1 (n = 73), raised myocardial native T2 (n = 60), myocardial late gadolinium enhancement (n = 32), or pericardial enhancement (n = 22). There was a small but significant difference between patients who recovered at home vs in the hospital for native T1 mapping (median [IQR], 1119 [1092-1150] ms vs 1141 [1121-1175] ms; P = .008) and hsTnT (4.2 [3.0-5.9] pg/dL vs 6.3 [3.4-7.9] pg/dL; P = .002) but not for native T2 mapping. None of these measures were correlated with time from COVID-19 diagnosis (native T1: r = 0.07; P = .47; native T2: r = 0.14; P = .15; hsTnT: r = -0.07; P = .50). High-sensitivity troponin T was significantly correlated with native T1 mapping (r = 0.33; P < .001) and native T2 mapping (r = 0.18; P = .01). Endomyocardial biopsy in patients with severe findings revealed active lymphocytic inflammation. Native T1 and T2 were the measures with the best discriminatory ability to detect COVID-19-related myocardial pathology. CONCLUSIONS AND RELEVANCE In this study of a cohort of German patients recently recovered from COVID-19 infection, CMR revealed cardiac involvement in 78 patients (78%) and ongoing myocardial inflammation in 60 patients (60%), independent of preexisting conditions, severity and overall course of the acute illness, and time from the original diagnosis. These findings indicate the need for ongoing investigation of the long-term cardiovascular consequences of COVID-19.
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Affiliation(s)
- Valentina O. Puntmann
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - M. Ludovica Carerj
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany,Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Imke Wieters
- Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Masia Fahim
- Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christophe Arendt
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany,Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Jedrzej Hoffmann
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany,Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Anastasia Shchendrygina
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany,Department of Hospital Therapy No. 1, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Mariuca Vasa-Nicotera
- Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Andreas M. Zeiher
- Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Maria Vehreschild
- Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany
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Elevated Cardiac Troponin T in Patients with Lupus Myositis Presenting with Noncardiac Chest Pain. Case Rep Rheumatol 2020; 2020:8884759. [PMID: 33149955 PMCID: PMC7603570 DOI: 10.1155/2020/8884759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/03/2020] [Accepted: 10/12/2020] [Indexed: 02/01/2023] Open
Abstract
Patients with systemic lupus erythematosus (SLE) presenting with chest pain pose a unique diagnostic challenge, with causes ranging from cardiopulmonary disease to esophageal disorders and musculoskeletal chest wall pain. The most common biomarkers for myocardial injury are cardiac troponin T and I (cTnT and cTnI) due to their high sensitivity for the early detection of myocardial infarction. In the idiopathic inflammatory myopathies, cTnT is commonly elevated, and this reflects skeletal muscle breakdown rather than myocardial damage. Similar observations have not been reported in SLE myositis to date. We present two cases of patients with SLE and associated myositis who presented with chest pain and elevated cTnT. Both patients had a normal cTnI, transthoracic echocardiogram, and cardiac magnetic resonance imaging, likely indicating noncardiac chest pain. Clinicians should be aware that the specificity of cTnT might be lower in SLE myositis and that cTnI elevation may be more specific in detecting myocardial insult.
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Fanouriakis A, Tziolos N, Bertsias G, Boumpas DT. Update οn the diagnosis and management of systemic lupus erythematosus. Ann Rheum Dis 2020; 80:14-25. [PMID: 33051219 DOI: 10.1136/annrheumdis-2020-218272] [Citation(s) in RCA: 290] [Impact Index Per Article: 72.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/15/2022]
Abstract
Clinical heterogeneity, unpredictable course and flares are characteristics of systemic lupus erythematosus (SLE). Although SLE is-by and large-a systemic disease, occasionally it can be organ-dominant, posing diagnostic challenges. To date, diagnosis of SLE remains clinical with a few cases being negative for serologic tests. Diagnostic criteria are not available and classification criteria are often used for diagnosis, yet with significant caveats. Newer sets of criteria (European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2019) enable earlier and more accurate classification of SLE. Several disease endotypes have been recognised over the years. There is increased recognition of milder cases at presentation, but almost half of them progress overtime to more severe disease. Approximately 70% of patients follow a relapsing-remitting course, the remaining divided equally between a prolonged remission and a persistently active disease. Treatment goals include long-term patient survival, prevention of flares and organ damage, and optimisation of health-related quality of life. For organ-threatening or life-threatening SLE, treatment usually includes an initial period of high-intensity immunosuppressive therapy to control disease activity, followed by a longer period of less intensive therapy to consolidate response and prevent relapses. Management of disease-related and treatment-related comorbidities, especially infections and atherosclerosis, is of paramount importance. New disease-modifying conventional and biologic agents-used alone, in combination or sequentially-have improved rates of achieving both short-term and long-term treatment goals, including minimisation of glucocorticoid use.
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Affiliation(s)
| | - Nikolaos Tziolos
- 4th Department of Internal Medicine, "Attikon" University Hospital, Athens, Greece
| | - George Bertsias
- Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Iraklio, Crete, Greece.,Laboratory of Autoimmunity-Inflammation, Institute of Molecular Biology and Biotechnology, Heraklion, Crete, Greece
| | - Dimitrios T Boumpas
- 4th Department of Internal Medicine, "Attikon" University Hospital, Athens, Greece .,Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Medical School, University of Cyprus, Nicosia, Cyprus.,Laboratory of Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, Athens, Cyprus
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34
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Diagnostic Accuracy of Mapping Techniques and Postprocessing Methods for Acute Myocarditis. AJR Am J Roentgenol 2020; 215:105-115. [DOI: 10.2214/ajr.19.22028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Snel GJH, van den Boomen M, Hernandez LM, Nguyen CT, Sosnovik DE, Velthuis BK, Slart RHJA, Borra RJH, Prakken NHJ. Cardiovascular magnetic resonance native T 2 and T 2* quantitative values for cardiomyopathies and heart transplantations: a systematic review and meta-analysis. J Cardiovasc Magn Reson 2020; 22:34. [PMID: 32393281 PMCID: PMC7212597 DOI: 10.1186/s12968-020-00627-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/16/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The clinical application of cardiovascular magnetic resonance (CMR) T2 and T2* mapping is currently limited as ranges for healthy and cardiac diseases are poorly defined. In this meta-analysis we aimed to determine the weighted mean of T2 and T2* mapping values in patients with myocardial infarction (MI), heart transplantation, non-ischemic cardiomyopathies (NICM) and hypertension, and the standardized mean difference (SMD) of each population with healthy controls. Additionally, the variation of mapping outcomes between studies was investigated. METHODS The PRISMA guidelines were followed after literature searches on PubMed and Embase. Studies reporting CMR T2 or T2* values measured in patients were included. The SMD was calculated using a random effects model and a meta-regression analysis was performed for populations with sufficient published data. RESULTS One hundred fifty-four studies, including 13,804 patient and 4392 control measurements, were included. T2 values were higher in patients with MI, heart transplantation, sarcoidosis, systemic lupus erythematosus, amyloidosis, hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM) and myocarditis (SMD of 2.17, 1.05, 0.87, 1.39, 1.62, 1.95, 1.90 and 1.33, respectively, P < 0.01) compared with controls. T2 values in iron overload patients (SMD = - 0.54, P = 0.30) and Anderson-Fabry disease patients (SMD = 0.52, P = 0.17) did both not differ from controls. T2* values were lower in patients with MI and iron overload (SMD of - 1.99 and - 2.39, respectively, P < 0.01) compared with controls. T2* values in HCM patients (SMD = - 0.61, P = 0.22), DCM patients (SMD = - 0.54, P = 0.06) and hypertension patients (SMD = - 1.46, P = 0.10) did not differ from controls. Multiple CMR acquisition and patient demographic factors were assessed as significant covariates, thereby influencing the mapping outcomes and causing variation between studies. CONCLUSIONS The clinical utility of T2 and T2* mapping to distinguish affected myocardium in patients with cardiomyopathies or heart transplantation from healthy myocardium seemed to be confirmed based on this meta-analysis. Nevertheless, variation of mapping values between studies complicates comparison with external values and therefore require local healthy reference values to clinically interpret quantitative values. Furthermore, disease differentiation seems limited, since changes in T2 and T2* values of most cardiomyopathies are similar.
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Affiliation(s)
- G J H Snel
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - M van den Boomen
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | - L M Hernandez
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - C T Nguyen
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | - D E Sosnovik
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
- Division of Health Sciences and Technology, Harvard-MIT, 7 Massachusetts Avenue, Cambridge, MA, 02139, USA
| | - B K Velthuis
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - R H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Biomedical Photonic Imaging, University of Twente, Dienstweg 1, 7522 ND, Enschede, The Netherlands
| | - R J H Borra
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - N H J Prakken
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Aortic Stiffness and Heart Failure in Chronic Kidney Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2020. [DOI: 10.1007/s12410-020-9534-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Abstract
Purpose of Review
To provide an update on the recent findings in the field of aortic stiffness and heart failure in patients with chronic kidney disease (CKD).
Recent Findings
Stratification of cardiovascular risk in CKD remains an open question. Recent reports suggest that aortic stiffness, an independent predictor of cardiovascular events in many patient populations, is also an important prognostic factor in CKD. Also, novel measures of myocardial tissue characterization, native T1 and T2 mapping techniques, have potential as diagnostic and prognostic factors in CKD.
Summary
Cardiovascular magnetic resonance has the ability to thoroughly evaluate novel imaging markers: aortic stiffness, native T1, and native T2. Novel imaging markers can be used for diagnostic and prognostic purposes as well as potential therapeutic targets in CKD population.
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Youyou Z, Yalei Y, Jie Z, Chuhuai G, Liang L, Liang R. Molecular biomarkers of cantharidin‐induced cardiotoxicity in Sprague‐Dawley rats: Troponin T, vascular endothelial growth factor and hypoxia inducible factor‐1α. J Appl Toxicol 2020; 40:1153-1161. [DOI: 10.1002/jat.3974] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/27/2020] [Accepted: 02/29/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Zhang Youyou
- Department of Forensic Medicine, Tongji Medical CollegeHuazhong University of Science and Technology Wuhan China
| | - Yu Yalei
- Department of Forensic Medicine, Tongji Medical CollegeHuazhong University of Science and Technology Wuhan China
| | - Zhang Jie
- Department of Forensic Medicine, Tongji Medical CollegeHuazhong University of Science and Technology Wuhan China
| | - Guan Chuhuai
- Department of Forensic Medicine, Tongji Medical CollegeHuazhong University of Science and Technology Wuhan China
| | - Liu Liang
- Department of Forensic Medicine, Tongji Medical CollegeHuazhong University of Science and Technology Wuhan China
| | - Ren Liang
- Department of Forensic Medicine, Tongji Medical CollegeHuazhong University of Science and Technology Wuhan China
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Cardiac Magnetic Resonance in Chagas Disease—an Update. CURRENT CARDIOVASCULAR IMAGING REPORTS 2020. [DOI: 10.1007/s12410-020-9532-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Abstract
Purpose of Review
To review the latest developments and the current role of the cardiac magnetic resonance (CMR) in pericardial diseases and their complications.
Recent Findings
Cardiac Magnetic Resonance (CMR) has the ability to incorporate anatomy, physiology, and “virtual histology” strategies to achieve the most accurate diagnosis for even the most demanding, pericardial diseases.
Summary
Acute, chronic, recurrent, and constrictive pericarditis as well as pericarditis related complications, pericardial masses and congenital pericardial defects are commonly encountered in clinical practice with relatively significant morbidity and mortality. Owing to the challenging diagnosis, CMR imaging is often employed in confirming the diagnosis and elucidating the underling pathophysiology. In this review we outline the common CMR techniques and their expected diagnostic outcomes.
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Arcari L, Hinojar R, Engel J, Freiwald T, Platschek S, Zainal H, Zhou H, Vasquez M, Keller T, Rolf A, Geiger H, Hauser I, Vogl TJ, Zeiher AM, Volpe M, Nagel E, Puntmann VO. Native T1 and T2 provide distinctive signatures in hypertrophic cardiac conditions - Comparison of uremic, hypertensive and hypertrophic cardiomyopathy. Int J Cardiol 2020; 306:102-108. [PMID: 32169347 DOI: 10.1016/j.ijcard.2020.03.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 02/26/2020] [Accepted: 03/02/2020] [Indexed: 02/06/2023]
Abstract
AIMS Profound left ventricular (LV) hypertrophy with diastolic dysfunction and heart failure is the cardinal manifestation of heart remodelling in chronic kidney disease (CKD). Previous studies related increased T1 mapping values in CKD with diffuse fibrosis. Native T1 is a non-specific readout that may also relate to increased intramyocardial fluid. We examined concomitant T1 and T2 mapping signatures and undertook comparisons with other hypertrophic conditions. METHODS In this prospective multicentre study, consecutive CKD patients (n = 154) undergoing routine clinical cardiac magnetic resonance (CMR) imaging were compared with patients with hypertensive (HTN, n = 163) and hypertrophic cardiomyopathy (HCM, n = 158), and normotensive controls (n = 133). RESULTS Native T1 was significantly higher in all patient groups, whereas native T2 in CKD only (p < 0.001 vs. all groups). Native T1 and T2 were interrelated in patient groups and the strength of association was condition-specific (CKD r = 0.558, HTN r = 0.324, both p < 0.001; HCM r = 0.157, p = 0.05). Native T1 and T2 were similarly correlated in all CKD stages (S3 r = 0.501, S4 0.586, S5 r = 0.424, p < 0.001 for all). Native T1 was the strongest myocardial discriminator between patients and controls (area under the curve, AUC HCM: 0.97; CKD: 0.97, HTN 0.98), native T2 between CKD vs HCM (AUC 0.90) and native T1 and T2 between CKD vs HTN (AUC: 0.83 and 0.80 respectively), p < 0.001 for all. CONCLUSIONS Our findings reveal different CMR signatures of common hypertrophic cardiac phenotypes. Native T1 was raised in all conditions, indicating the presence of pathologic hypertrophic remodelling. Markedly raised native T2 was CKD-specific, suggesting a prominent role of intramyocardial fluid.
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Affiliation(s)
- Luca Arcari
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany; Cardiology Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Rocio Hinojar
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain
| | - Juergen Engel
- Department of Nephrology, Goethe University Hospital Frankfurt, Frankfuret-am Main, Germany
| | - Tilo Freiwald
- Department of Nephrology, Goethe University Hospital Frankfurt, Frankfuret-am Main, Germany
| | - Steffen Platschek
- Department of Nephrology, Goethe University Hospital Frankfurt, Frankfuret-am Main, Germany
| | - Hafisyatul Zainal
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Cardiology, Universiti Teknologi MARA (UiTM), Sg. Buloh, Malaysia
| | - Hui Zhou
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Radiology, XiangYa Hospital, Central South University, Changsha, Hunan, China
| | - Moises Vasquez
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Cardiology, Enrique Baltodano Briceño Hospital, Liberia, Costa Rica
| | - Till Keller
- Department of Cardiology, Kerckhoff Hospital, University Giessen, Bad Nauheim, Germany
| | - Andreas Rolf
- Department of Cardiology, Kerckhoff Hospital, University Giessen, Bad Nauheim, Germany
| | - Helmut Geiger
- Department of Nephrology, Goethe University Hospital Frankfurt, Frankfuret-am Main, Germany
| | - Ingeborg Hauser
- Department of Nephrology, Goethe University Hospital Frankfurt, Frankfuret-am Main, Germany
| | - Thomas J Vogl
- Department of Radiology, Goethe University Hospital Frankfurt, Frankfurt-am Main, Germany
| | - Andreas M Zeiher
- Department of Radiology, Goethe University Hospital Frankfurt, Frankfurt-am Main, Germany
| | - Massimo Volpe
- Cardiology Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy
| | - Eike Nagel
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Valentina O Puntmann
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt-am Main, Germany.
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41
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Kolentinis M, Le M, Nagel E, Puntmann VO. Contemporary Cardiac MRI in Chronic Coronary Artery Disease. Eur Cardiol 2020; 15:e50. [PMID: 32612708 PMCID: PMC7312615 DOI: 10.15420/ecr.2019.17] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 02/17/2020] [Indexed: 12/12/2022] Open
Abstract
Chronic coronary artery disease remains an unconquered clinical problem, affecting an increasing number of people worldwide. Despite the improved understanding of the disease development, the implementation of the many advances in diagnosis and therapy is lacking. Many clinicians continue to rely on patient's symptoms and diagnostic methods, which do not enable optimal clinical decisions. For example, echocardiography and invasive coronary catheterisation remain the mainstay investigations for stable angina patients in many places, despite the evidence on their limitations and availability of better diagnostic options. Cardiac MRI is a powerful diagnostic method, supporting robust measurements of crucial markers of cardiac structure and function, myocardial perfusion and scar, as well as providing detailed insight into myocardial tissue. Accurate and informative diagnostic readouts can help with guiding therapy, monitoring disease progress and tailoring the response to treatment. In this article, the authors outline the evidence supporting the state-of-art applications based on cardiovascular magnetic resonance, allowing the clinician optimal use of this insightful diagnostic method in everyday clinical practice.
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Affiliation(s)
- Michalis Kolentinis
- Institute of Experimental and Translational Cardiovascular Imaging, German Centre for Cardiovascular Research (DZHK) Centre for Cardiovascular Imaging, Partner Site Rhein-Main, University Hospital Frankfurt Frankfurt, Germany
| | - Melanie Le
- Institute of Experimental and Translational Cardiovascular Imaging, German Centre for Cardiovascular Research (DZHK) Centre for Cardiovascular Imaging, Partner Site Rhein-Main, University Hospital Frankfurt Frankfurt, Germany
| | - Eike Nagel
- Institute of Experimental and Translational Cardiovascular Imaging, German Centre for Cardiovascular Research (DZHK) Centre for Cardiovascular Imaging, Partner Site Rhein-Main, University Hospital Frankfurt Frankfurt, Germany
| | - Valentina O Puntmann
- Institute of Experimental and Translational Cardiovascular Imaging, German Centre for Cardiovascular Research (DZHK) Centre for Cardiovascular Imaging, Partner Site Rhein-Main, University Hospital Frankfurt Frankfurt, Germany
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42
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Mendoza-Pinto C, Rojas-Villarraga A, Molano-González N, García-Carrasco M, Munguía-Realpozo P, Etchegaray-Morales I, Morales-Sánchez H, Berra-Romani R, Cervera R. Endothelial dysfunction and arterial stiffness in patients with systemic lupus erythematosus: A systematic review and meta-analysis. Atherosclerosis 2020; 297:55-63. [PMID: 32078830 DOI: 10.1016/j.atherosclerosis.2020.01.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/23/2020] [Accepted: 01/30/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS Non-invasive surrogates of cardiovascular (CV) disease such as endothelial dysfunction (ED) and peripheral arterial stiffness (AS) have been evaluated in systemic lupus erythematosus (SLE) patients. The aim of this study was to systematically review and meta-analyze reports of cardiovascular disease (CVD) in SLE patients, as measured by ED and AS. METHODS Studies analyzing the relationship of SLE with ED (flow-mediated dilatation [FMD], nitroglycerin-mediated dilatation [NMD] and peripheral arterial tonometry [PAT]) and AS (augmentation index [AIx], pulse wave velocity [PWV]) were systematically searched for in PubMed, Cochrane library, EMBASE, VHL, SciELO and Web of Science databases. Inclusion criteria included peer-review and English language. Mean differences (MD) and 95% confidence intervals (CIs) were estimated using the random effect model. The study was registered with PROSPERO, number CRD42019121068. RESULTS The meta-analysis included 49 studies. FMD data from 18 studies including 943 SLE subjects (mean age = 38.71 [95%CI 36.21, 41.21] years) and 644 unaffected controls (mean age = 38.63 [95%CI 36.11, 41.15] years) were included. When compared with unaffected controls, FMD in SLE subjects was decreased by 4.3% (95%CI: -6.13%, -2.47%): p < 0.001). However, NMD did not significantly differ between SLE patients and controls (MD = - 2.68%; 95% CI -6.00, 0.62; p = 0.11). A significantly increased AS between SLE patients and controls according to overall PWV (MD = 1.12 m/s; 95% CI 0.72-1.52; p < 0.001) was observed, but not for the brachial-ankle PWV. AIx was also increased in SLE patients compared with healthy controls (MD = 4.55%; 95% CI 1.48-7.63; p = 0.003). CONCLUSIONS Overall, SLE patients showed impaired FMD, an independent predictor of CV events. There was a higher degree of AS in SLE patients compared with controls. ED and AS in SLE should be considered when planning preventive strategies and therapies.
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Affiliation(s)
- Claudia Mendoza-Pinto
- Systemic Autoimmune Diseases Research Unit, High Specialized Medical Unit, UMAE CMNMAC - CIBIOR, Mexican Social Security Institute, Puebla, Mexico; Department of Immunology and Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | | | - Nicolás Molano-González
- Clinical Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Mario García-Carrasco
- Systemic Autoimmune Diseases Research Unit, High Specialized Medical Unit, UMAE CMNMAC - CIBIOR, Mexican Social Security Institute, Puebla, Mexico; Department of Immunology and Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico.
| | - Pamela Munguía-Realpozo
- Systemic Autoimmune Diseases Research Unit, High Specialized Medical Unit, UMAE CMNMAC - CIBIOR, Mexican Social Security Institute, Puebla, Mexico; Department of Immunology and Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Ivet Etchegaray-Morales
- Department of Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Héctor Morales-Sánchez
- Department of Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Roberto Berra-Romani
- Department of Biomedicine, School of Medicine, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Catalonia, Spain
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43
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Zanatta E, Colombo C, D’Amico G, d’Humières T, Dal Lin C, Tona F. Inflammation and Coronary Microvascular Dysfunction in Autoimmune Rheumatic Diseases. Int J Mol Sci 2019; 20:ijms20225563. [PMID: 31703406 PMCID: PMC6888405 DOI: 10.3390/ijms20225563] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/31/2019] [Accepted: 11/05/2019] [Indexed: 02/07/2023] Open
Abstract
Autoimmune rheumatic diseases (ARDs) form a heterogeneous group of disorders that include systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis (RA), idiopathic inflammatory myopathies (IIMs), and systemic vasculitis. Coronary microvascular dysfunction (CMD) is quite common in patients with ARDs and is linked to increased cardiovascular morbidity and mortality. Inflammation plays a crucial role in the pathogenesis of both accelerated atherosclerosis and CMD in ARDs, especially in patients affected by SLE and RA. In this regard, some studies have highlighted the efficacy of immunosuppressants and/or biologics in restoring CMD in these patients. By contrast, the role of inflammation in the pathogenesis of CMD-SSc appears to be much less relevant compared to endothelial dysfunction and microvascular ischemia, with calcium-channel blockers providing some benefits. Few studies have endeavored to assess the occurrence of CMD in IIMs and systemic vasculitis, thus warranting further investigations. The present review summarizes the current evidence on the occurrence of CMD in ARDs, focusing on the role of inflammation and possible therapeutic approaches.
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Affiliation(s)
| | - Claudia Colombo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, 35128 Padua, Italy; (C.C.); (G.D.); (C.D.L.)
| | - Gianpiero D’Amico
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, 35128 Padua, Italy; (C.C.); (G.D.); (C.D.L.)
| | - Thomas d’Humières
- Department of Cardiovascular Physiology, AP-HP, Henri-Mondor Teaching Hospital, 94010 Créteil, France;
| | - Carlo Dal Lin
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, 35128 Padua, Italy; (C.C.); (G.D.); (C.D.L.)
| | - Francesco Tona
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, 35128 Padua, Italy; (C.C.); (G.D.); (C.D.L.)
- Correspondence:
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44
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Mavrogeni SI, Markousis-Mavrogenis G, Karapanagiotou O, Toutouzas K, Argyriou P, Velitsista S, Kanoupakis G, Apostolou D, Hautemann D, Sfikakis PP, Tektonidou MG. Silent Myocardial Perfusion Abnormalities Detected by Stress Cardiovascular Magnetic Resonance in Antiphospholipid Syndrome: A Case-Control Study. J Clin Med 2019; 8:E1084. [PMID: 31340567 PMCID: PMC6678220 DOI: 10.3390/jcm8071084] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/12/2019] [Accepted: 07/20/2019] [Indexed: 12/17/2022] Open
Abstract
Objective: To examine the prevalence of silent myocardial ischemia and fibrosis in antiphospholipid syndrome (APS), using stress cardiovascular magnetic resonance (CMR). Methods: Forty-four consecutive APS patients without prior cardiac disease (22 primary APS, 22 systemic lupus erythematosus (SLE)/APS, mean age 44 (12.9) years, 64% women) and 44 age/gender-matched controls were evaluated using CMR at 1.5 T. Steady-state free precession imaging for function assessment and adenosine stress-CMR for perfusion-fibrosis evaluation were employed. The myocardial perfusion reserve index (MPRI), and myocardial fibrosis expressed as late gadolinium enhancement (LGE), were evaluated. Coronary angiography was indicated in patients with LGE. Associations with APS characteristics, classic cardiovascular disease (CVD) risk factors, high-sensitivity CRP (hs-CRP) and high-sensitivity Troponin (hs-TnT) levels were tested. All patients were followed up for 12 months. Results: Median MPRI was significantly lower in APS patients versus controls [1.5 (0.9-1.9) vs. 2.7 (2.2-3.2), p < 0.001], independently of any LGE presence. LGE was detected in 16 (36.3%) patients versus none of controls (p < 0.001); 12/16 were subsequently examined with coronary angiography and only two of them had coronary artery lesions. In multivariable analysis, none of the APS-related and classic CVD risk factors, or hs-CRP and hs-TnT covariates, were significant predictors of abnormal MPRI or LGE. At the twelve month follow-up, three (6.8%) patients experienced coronary artery disease, notably those with the lowest MPRI values. Conclusions: Abnormal MPRI and LGE are common in asymptomatic APS patients, independently so of any APS-related and classic CVD risk factors, or coronary angiography findings in cases with LGE. Stress-CMR is a valuable tool to detect silent myocardial ischemia and fibrosis in APS.
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Affiliation(s)
| | | | | | - Konstantinos Toutouzas
- First Cardiology Department, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | | | | | | | - David Hautemann
- Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Maria G Tektonidou
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece.
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45
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Seraphim A, Knott KD, Augusto J, Bhuva AN, Manisty C, Moon JC. Quantitative cardiac MRI. J Magn Reson Imaging 2019; 51:693-711. [PMID: 31111616 DOI: 10.1002/jmri.26789] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/29/2019] [Indexed: 12/22/2022] Open
Abstract
Cardiac MRI has become an indispensable imaging modality in the investigation of patients with suspected heart disease. It has emerged as the gold standard test for cardiac function, volumes, and mass and allows noninvasive tissue characterization and the assessment of myocardial perfusion. Quantitative MRI already has a key role in the development and incorporation of machine learning in clinical imaging, potentially offering major improvements in both workflow efficiency and diagnostic accuracy. As the clinical applications of a wide range of quantitative cardiac MRI techniques are being explored and validated, we are expanding our capabilities for earlier detection, monitoring, and risk stratification of disease, potentially guiding personalized management decisions in various cardiac disease models. In this article we review established and emerging quantitative techniques, their clinical applications, highlight novel advances, and appraise their clinical diagnostic potential. Level of Evidence: 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2020;51:693-711.
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Affiliation(s)
- Andreas Seraphim
- University College London, Institute of Cardiovascular Science, London, UK.,Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Kristopher D Knott
- University College London, Institute of Cardiovascular Science, London, UK.,Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Joao Augusto
- University College London, Institute of Cardiovascular Science, London, UK.,Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Anish N Bhuva
- University College London, Institute of Cardiovascular Science, London, UK.,Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Charlotte Manisty
- University College London, Institute of Cardiovascular Science, London, UK.,Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - James C Moon
- University College London, Institute of Cardiovascular Science, London, UK.,Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
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46
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Cardiac MRI: a Promising Diagnostic Tool to Detect Cancer Therapeutics–Related Cardiac Dysfunction. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9489-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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47
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Zhou H, Zainal H, Puntmann VO. Non-infarcted myocardium bears the weight in CVD. Aging (Albany NY) 2019; 11:1609-1610. [PMID: 30908271 PMCID: PMC6461182 DOI: 10.18632/aging.101890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 03/21/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Hui Zhou
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Frankfurt, Germany.,Department of Radiology, XiangYa Hospital, Central South University, Changsha, Hunan, China
| | - Hafisyatul Zainal
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Frankfurt, Germany.,Department of Cardiology, Universiti Teknologi MARA (UiTM), Sg. Buloh, Malaysia
| | - Valentina O Puntmann
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Frankfurt, Germany
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