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Rheumatology International

, Volume 38, Issue 6, pp 949–958 | Cite as

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

  • Sophie I. Mavrogeni
  • Petros P. Sfikakis
  • Theodoros Dimitroulas
  • Loukia Koutsogeorgopoulou
  • Gikas Katsifis
  • George Markousis-Mavrogenis
  • Genovefa Kolovou
  • George D. Kitas
Expert Opinion

Abstract

Life expectancy in autoimmune rheumatic diseases (ARDs) remains lower compared to the general population, due to various comoborbidities. Cardiovascular disease (CVD) represents the main contributor to premature mortality. Conventional and biologic disease-modifying antirheumatic drugs (DMARDs) have considerably improved long-term outcomes in ARDs not only by suppressing systemic inflammation but also by lowering CVD burden. Regarding atherosclerotic disease prevention, EULAR has recommended tight disease control accompanied by regular assessment of traditional CVD risk factors and lifestyle changes. However, this approach, although rational and evidence-based, does not account for important issues such as myocardial inflammation and the long asymptomatic period that usually proceeds clinical manifestations of CVD disease in ARDs before or after the diagnosis of systemic disease. Cardiovascular magnetic resonance (CMR) can offer reliable, reproducible and operator independent information regarding myocardial inflammation, ischemia and fibrosis. Some studies suggest a role for CMR in the risk stratification of ARDs and demonstrate that oedema/fibrosis visualisation with CMR may have the potential to inform cardiac and rheumatic treatment modification in ARDs with or without abnormal routine cardiac evaluation. In this review, we discuss how CMR findings could influence anti-rheumatic treatment decisions targeting optimal control of both systemic and myocardial inflammation irrespective of clinical manifestations of cardiac disease. CMR can provide a different approach that is very promising for risk stratification and treatment modification; however, further studies are needed before the inclusion of CMR in the routine evaluation and treatment of patients with ARDs.

Keywords

Rheumatic diseases Cardiovascular magnetic resonance imaging Cardiovascular diseases 

Notes

Author contributions

SM: responsible for conceiving and manuscript writing. PPS: literature searching and manuscript writing. TD: literature searching and manuscript writing. LK: literature searching and manuscript writing. GK: literature searching and manuscript writing. GMM: literature searching and manuscript writing. GK: literature evaluation and writing supervision. GDK: literature evaluation and writing supervision.

Compliance with ethical standards

Conflict of interest

There is no conflict of interest for any of the authors.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Research involving human participants and/or animals

N/A. It is a review study.

Informed consent

N/A. It is a review study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Sophie I. Mavrogeni
    • 1
  • Petros P. Sfikakis
    • 2
  • Theodoros Dimitroulas
    • 3
  • Loukia Koutsogeorgopoulou
    • 4
  • Gikas Katsifis
    • 5
  • George Markousis-Mavrogenis
    • 1
  • Genovefa Kolovou
    • 1
  • George D. Kitas
    • 6
  1. 1.Onassis Cardiac Surgery CenterAthensGreece
  2. 2.First Department of Propaedeutic and Internal MedicineNational and Kapodisstrian University of Athens Medical SchoolAthensGreece
  3. 3.4th Department of Internal Medicine, Hippokration University Hospital, Medical SchoolAristotle University of ThessalonikiThessalonikiGreece
  4. 4.Pathophysiology DepartmentNational and Kapodisstrian University of Athens Medical SchoolAthensGreece
  5. 5.Naval HospitalAthensGreece
  6. 6.Arthritis Research UK Epidemiology UnitManchester UniversityManchesterUK

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