Imaging Risk in Multisystem Inflammatory Diseases

JACC Cardiovasc Imaging. 2019 Dec;12(12):2517-2537. doi: 10.1016/j.jcmg.2018.06.033. Epub 2019 Mar 13.

Abstract

Rheumatic diseases are immune-mediated inflammatory multisystem diseases with frequent cardiovascular manifestations including perimyocarditis, valvular disease, coronary artery disease, heart failure with or without preserved ejection fraction, pulmonary hypertension, aneurysms, and thrombosis. Echocardiography, carotid ultrasonography, cardiac computed tomography, cardiac magnetic resonance imaging, and positron emission tomography are valid diagnostic tools for the detection of the cardiovascular complications of the multisystem diseases that frequently determine prognosis. Furthermore, the findings of these methods may offer additive risk stratification in asymptomatic patients over the conventional risk scores used to assess cardiovascular risk in the primary prevention setting. Finally, the imaging methods offer a unique opportunity to monitor the effects of treatment on atherosclerotic lesions, coronary microcirculatory dysfunction, myocardial inflammation and fibrosis. However, studies are needed to investigate whether improvement of imaging markers by treatment or selection of treatment according to its effects on surrogate imaging markers is linked to improved prognosis.

Keywords: cardiac imaging; cardiovascular risk; echocardiography; inflammatory diseases; rheumatoid arthritis; systemic lupus erythematosus; systemic sclerosis; vasculitis.

Publication types

  • Review

MeSH terms

  • Cardiac Imaging Techniques*
  • Cardiovascular Diseases / diagnostic imaging*
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / physiopathology
  • Cardiovascular Diseases / therapy
  • Cardiovascular System / diagnostic imaging*
  • Cardiovascular System / physiopathology
  • Humans
  • Inflammation / complications*
  • Inflammation / diagnosis
  • Inflammation / therapy
  • Predictive Value of Tests
  • Prognosis
  • Risk Assessment
  • Risk Factors