Advanced Myocardial Tissue Characterization by a multi-component CMR Protocol in Patients with Rheumatoid Arthritis

Zielsetzung:

Rheumatoid arthritis (RA) patients are at increased risk of suffering from adverse cardiovascular events. These potential life-threatening consequences often face a subclinical presentation, normal left ventricular ejection fraction (LV-EF) and normal ECG. Hence, advanced myocardial tissue characterization in early, potential modifiable stages is highly desirable. Late gadolinium enhancement (LGE)-cardiovascular magnetic resonance (CMR) alone with its ability to detect focal myocardial lesions may not be sufficient since RA patients are also known to show diffuse inflammation/fibrosis. Therefore, CMR mapping techniques might be appropriate tools to complement LGE for the assessment of myocardial involvement. Aim of this study was to perform advanced myocardial tissue characterization in RA patients by a multi-component CMR protocol, including LGE and T1/T2 mapping sequences.

Material und Methodik:

22 RA patients were prospectively enrolled and underwent CMR, 20 volunteers served as controls.

Ergebnisse:

Mean LV-EF was 66%; prevalence of LGE was 18%. RA patients had increased native T1 (985 vs. 959 ms, p = 0.03), expanded extracellular volume (ECV) (27 vs. 25%, p = 0.02), and higher T2 values (52 vs. 49 ms, p < 0.001) compared to controls irrespective of the presence of LGE. T2 mapping showed the highest prevalence of values beyond the 95% percentile of controls.

Schlussfolgerungen:

RA patients demonstrated higher T1, ECV, and T2 values compared to controls, with most significant differences for T2. Since these results seem to be independent of the presence of LGE, advanced myocardial tissue characterization including CMR mapping techniques in addition to LGE-CMR might be useful in the evaluation of myocardial involvement in RA patients.