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Broncano J, Vargas D, Bhalla S, Cummings KW, Raptis CA, Luna A. CT and MR Imaging of Cardiothoracic Vasculitis. Radiographics 2018; 38:997-1021. [PMID: 29883266 DOI: 10.1148/rg.2018170136] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The term vasculitis includes a variable group of entities in which the common characteristic is inflammation of the walls of blood vessels occurring at some time during the course of the disease. The vasculitides can be divided into primary and secondary vasculitides, depending on the etiology and according to the size of the vessel affected. Both primary vasculitis and secondary vasculitis are associated with cardiac morbidity that is often subclinical. Cardiac involvement is associated with prognostic implications and higher rates of related mortality. Vasculitis of cardiac structures and the assessment of disease extent are important for appropriate management and selection of treatment. Although echocardiography, radionuclide imaging, and catheter-directed coronary angiography remain the cornerstones of cardiac imaging, cardiac computed tomography and magnetic resonance imaging can offer a 360° assessment of cardiac anatomy, function, and complications secondary to vasculitis. Postoperative complications, which are more frequent in patients with active disease, can also be depicted with those imaging modalities. A multidisciplinary approach is important to yield an appropriate estimate of the disease activity and extent and, therefore, to enable better treatment selection and monitoring. Online supplemental material is available for this article. ©RSNA, 2018.
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Affiliation(s)
- Jordi Broncano
- From the Department of Radiology, Ressalta Health Time Group, Hospital Cruz Roja, Avenida Paseo de la Victoria s/n, Córdoba 14004, Spain (J.B.); Department of Radiology, University of Colorado, Denver, Colo (D.V.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., C.A.R.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.); and MRI Section, Health Time, Jaén, Spain, and Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.)
| | - Daniel Vargas
- From the Department of Radiology, Ressalta Health Time Group, Hospital Cruz Roja, Avenida Paseo de la Victoria s/n, Córdoba 14004, Spain (J.B.); Department of Radiology, University of Colorado, Denver, Colo (D.V.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., C.A.R.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.); and MRI Section, Health Time, Jaén, Spain, and Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.)
| | - Sanjeev Bhalla
- From the Department of Radiology, Ressalta Health Time Group, Hospital Cruz Roja, Avenida Paseo de la Victoria s/n, Córdoba 14004, Spain (J.B.); Department of Radiology, University of Colorado, Denver, Colo (D.V.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., C.A.R.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.); and MRI Section, Health Time, Jaén, Spain, and Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.)
| | - Kristopher W Cummings
- From the Department of Radiology, Ressalta Health Time Group, Hospital Cruz Roja, Avenida Paseo de la Victoria s/n, Córdoba 14004, Spain (J.B.); Department of Radiology, University of Colorado, Denver, Colo (D.V.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., C.A.R.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.); and MRI Section, Health Time, Jaén, Spain, and Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.)
| | - Constantine A Raptis
- From the Department of Radiology, Ressalta Health Time Group, Hospital Cruz Roja, Avenida Paseo de la Victoria s/n, Córdoba 14004, Spain (J.B.); Department of Radiology, University of Colorado, Denver, Colo (D.V.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., C.A.R.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.); and MRI Section, Health Time, Jaén, Spain, and Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.)
| | - Antonio Luna
- From the Department of Radiology, Ressalta Health Time Group, Hospital Cruz Roja, Avenida Paseo de la Victoria s/n, Córdoba 14004, Spain (J.B.); Department of Radiology, University of Colorado, Denver, Colo (D.V.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., C.A.R.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.); and MRI Section, Health Time, Jaén, Spain, and Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.)
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Cardiac Function and Diastolic Dysfunction in Behcet's Disease: A Systematic Review and Meta-Analysis. Int J Rheumatol 2016; 2016:9837184. [PMID: 27247574 PMCID: PMC4877481 DOI: 10.1155/2016/9837184] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 04/13/2016] [Indexed: 11/17/2022] Open
Abstract
Background. Cardiovascular involvement in Behcet's disease (BD) is reported and has variable manifestations. It is not clear if diastolic dysfunction (DD) is increased in BD. Our objective was to evaluate the existing literature to determine if cardiac dysfunction, particularly DD, was more prevalent in these patients. Methods. A systematic review and meta-analysis of the available studies analyzing the echocardiographic findings in BD was conducted using a random-effects model. Mean differences were used to calculate the effect sizes of the echocardiographic parameters of interest. Results. A total of 22 studies with 1624 subjects were included in the analysis. Patients with BD had statistically significantly larger mean left atrial dimension (0.08, p = 0.0008), greater aortic diameter (0.16, p = 0.02), significantly reduced ejection fraction (−1.08, p < 0.0001), significantly prolonged mitral deceleration time (14.20, p < 0.0001), lower E/A ratio (−0.24, p = 0.05), and increased isovolumetric relaxation time (7.29, p < 0.00001). Conclusion. DD is increased in patients with BD by the presence of several echocardiographic parameters favoring DD as compared to controls. The meta-analysis also identified that LA dimension is increased in BD patients. EF has also been found to be lower in BD patients. Aortic diameter was also increased in BD patients as compared to controls.
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