Ntobeko A B Ntusi1, Stefan K Piechnik2, Jane M Francis2, Vanessa M Ferreira2, Paul M Matthews3, Matthew D Robson2, Paul B Wordsworth4, Stefan Neubauer2, Theodoros D Karamitsos5. 1. University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom; Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa. 2. University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom. 3. GlaxoSmithKline Clinical Imaging Centre, London, United Kingdom; Division of Brain Sciences, Department of Medicine, Imperial College, London, United Kingdom. 4. Botnar Institute, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre and John Radcliffe Hospital, Oxford, United Kingdom. 5. University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom; 1st Department of Cardiology, AHEPA Hospital, Aristotle University, Thessaloniki, Greece. Electronic address: theo.karamitsos@cardiov.ox.ac.uk.
Abstract
OBJECTIVES: The goal of this study was to assess the diffuse myocardial fibrosis and edema in rheumatoid arthritis (RA) using multiparametric cardiac magnetic resonance (CMR) and the association of myocardial T1 and extracellular volume (ECV) with disease activity, duration, and cardiac function. BACKGROUND: RA is a connective tissue disorder, with frequent cardiovascular disease. Myocardial inflammation and diffuse fibrosis can be detected noninvasively by using native T1 mapping and ECV quantification on CMR. METHODS: Thirty-nine RA patients (28 women; mean age 50 ± 12 years) and 39 matched control subjects (28 women; mean age 49 ± 12 years) underwent CMR at 1.5-T, including cine, tagging, T2-weighted, native T1 mapping (shortened modified Look-Locker inversion recovery), late gadolinium enhancement (LGE), and ECV imaging. RESULTS: Focal fibrosis on LGE was found in 46% of RA patients compared with none of the control subjects. Patients with RA had larger areas of focal myocardial edema (10% vs. 0%), higher native T1 values (973 ± 27 ms vs. 961 ± 18 ms; p = 0.03), larger areas of involvement as detected by native T1 >990 ms (35% vs. 2%; p < 0.001), and expansion of ECV (30.3 ± 3.4% vs. 27.9 ± 2.0%; p < 0.001) compared with control subjects. Left ventricular volumes, mass, and ejection fraction were similar between RA patients and control subjects. Peak systolic circumferential strain (-16.9 ± 1.3 vs. -18.7 ± 1.2; p < 0.001) and peak diastolic circumferential strain rate (83 ± 21 s(-1) vs. 112 ± 20 s(-1); p < 0.001) were impaired in RA patients. Myocardial T1 and ECV were correlated with myocardial strain and RA disease activity. CONCLUSIONS: Subclinical cardiovascular disease is frequent in RA, including focal and diffuse myocardial fibrosis and inflammation, which are associated with impaired strain and RA disease activity. CMR T1 mapping provides potential added value as a biomarker for disease monitoring and study of therapies aimed at reducing diffuse myocardial fibrosis in RA.
OBJECTIVES: The goal of this study was to assess the diffuse myocardial fibrosis and edema in rheumatoid arthritis (RA) using multiparametric cardiac magnetic resonance (CMR) and the association of myocardial T1 and extracellular volume (ECV) with disease activity, duration, and cardiac function. BACKGROUND:RA is a connective tissue disorder, with frequent cardiovascular disease. Myocardial inflammation and diffuse fibrosis can be detected noninvasively by using native T1 mapping and ECV quantification on CMR. METHODS: Thirty-nine RApatients (28 women; mean age 50 ± 12 years) and 39 matched control subjects (28 women; mean age 49 ± 12 years) underwent CMR at 1.5-T, including cine, tagging, T2-weighted, native T1 mapping (shortened modified Look-Locker inversion recovery), late gadolinium enhancement (LGE), and ECV imaging. RESULTS: Focal fibrosis on LGE was found in 46% of RApatients compared with none of the control subjects. Patients with RA had larger areas of focal myocardial edema (10% vs. 0%), higher native T1 values (973 ± 27 ms vs. 961 ± 18 ms; p = 0.03), larger areas of involvement as detected by native T1 >990 ms (35% vs. 2%; p < 0.001), and expansion of ECV (30.3 ± 3.4% vs. 27.9 ± 2.0%; p < 0.001) compared with control subjects. Left ventricular volumes, mass, and ejection fraction were similar between RApatients and control subjects. Peak systolic circumferential strain (-16.9 ± 1.3 vs. -18.7 ± 1.2; p < 0.001) and peak diastolic circumferential strain rate (83 ± 21 s(-1) vs. 112 ± 20 s(-1); p < 0.001) were impaired in RApatients. Myocardial T1 and ECV were correlated with myocardial strain and RA disease activity. CONCLUSIONS: Subclinical cardiovascular disease is frequent in RA, including focal and diffuse myocardial fibrosis and inflammation, which are associated with impaired strain and RA disease activity. CMR T1 mapping provides potential added value as a biomarker for disease monitoring and study of therapies aimed at reducing diffuse myocardial fibrosis in RA.
Authors: William Bradham; Michelle J Ormseth; Comfort Elumogo; Srikanth Palanisamy; Chia-Ying Liu; Mark A Lawson; Jonathan H Soslow; Nadine Kawel-Boehm; David A Bluemke; C Michael Stein Journal: J Rheumatol Date: 2018-04-15 Impact factor: 4.666
Authors: Francesco Sardanelli; Simone Schiaffino; Moreno Zanardo; Francesco Secchi; Paola Maria Cannaò; Federico Ambrogi; Giovanni Di Leo Journal: Eur Radiol Date: 2019-05-02 Impact factor: 5.315
Authors: Omar Niss; Robert Fleck; Fowe Makue; Tarek Alsaied; Payal Desai; Jeffrey A Towbin; Punam Malik; Michael D Taylor; Charles T Quinn Journal: Blood Date: 2017-05-15 Impact factor: 22.113
Authors: P Stefan Biesbroek; Sjoerd C Heslinga; Peter M van de Ven; Mike J L Peters; Raquel P Amier; Thelma C Konings; Christopher D Maroules; Colby Ayers; Parag H Joshi; Irene E van der Horst-Bruinsma; Vokko P van Halm; Albert C van Rossum; Michael T Nurmohamed; Robin Nijveldt Journal: Clin Rheumatol Date: 2018-05-12 Impact factor: 2.980
Authors: Mateus D Marques; Victor Nauffal; Bharath Ambale-Venkatesh; Henrique D Vasconcellos; Colin Wu; Hossein Bahrami; Russell P Tracy; Mary Cushman; David A Bluemke; João A C Lima Journal: Hypertension Date: 2018-10 Impact factor: 10.190