- Oral presentation
- Open Access
Myocardial tissue characterisation with late gadolinium enhancement in rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis
© Ntusi et al; licensee BioMed Central Ltd. 2013
- Published: 30 January 2013
- Rheumatoid Arthritis
- Systemic Lupus Erythematosus
- Cardiovascular Magnetic Resonance
- Systemic Lupus Erythematosus Patient
- Late Gadolinium Enhancement
Rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) commonly involve the cardiovascular system, and are associated with high morbidity and mortality. Mechanisms of cardiovascular disease (CVD) involvement in these clinical entities are not fully understood. Furthermore, little is known about myocardial structure and function in these inflammatory arthropathies. Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging is a tool for noninvasive evaluation of myocardial fibrosis that has the advantage over other imaging techniques of being able to directly visualise both ischaemic and non-ischaemic patterns of injury, and has prognostic significance. The purpose of this study was to assess the frequency and pattern of LGE in RA, SLE and SSc patients without any known CVD using CMR and to determine its relation to disease duration, vascular function (aortic distensibility; pulse wave velocity) and left ventricular (LV) systolic function (LV ejection fraction; mid short axis circumferential systolic strain).
59 RA patients (42 female, mean age 53 ± 12), 29 SLE patients (28 female, mean age 42 ± 10), 18 SSc patients (17 female, mean age 55 ± 10), 45 normal controls (38 female, mean age 44 ± 12), and 14 controls with cardiovascular risk factors [CVRFs] (11 female, mean age 52 ± 8) underwent CMR at 1.5 Tesla. All patients with previously known CVD were excluded. Biventricular volumes and function, presence and pattern of LGE, myocardial strain and vascular function were assessed by CMR.
Frequency and patterns of LGE in RA, SLE and SSc patients and in normal controls and controls with CVRFs.
Normal controls N=45
Controls with CVRFs N=14
Frequency of LGE
Pattern of LGE Basal inferolateral LGE Lateral wall midwall/subepicardial LGE Septal midwall LGE Myocardial infarction
1 (2.2) 1 (2.2) 2 (4.4) 0 (0)
2 (14.3) 0 (0) 1 (7.1) 0 (0)
16 (27.1) 5 (8.5) 3 (5.1) 3 (5.1)
5 (17.2) 2 (6.9) 0 (0) 2 (6.9)
4 (22.2) 5 (27.8) 0 (0) 0 (0)
<0.001 <0.001 <0.001 <0.001
CMR demonstrates an increased burden of both ischaemic and non-ischaemic fibrosis in patients with inflammatory systemic diseases with no known CVD. Increased myocardial fibrosis may contribute to the poor cardiovascular outcomes in this group of patients. LGE in RA, SLE and SSc correlates with increasing disease duration, impaired myocardial strain, and increased pulse wave velocity.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.