Deciphering cardiac involvement in systemic inflammatory diseases: noninvasive tissue characterisation using cardiac magnetic resonance is key to improved patients’ care

ABSTRACT

Introduction: Cardiac involvement in systemic inflammatory diseases (SID) has a major impact on patients’ morbidity and mortality, yet the pathways to its recognition and management remain poorly established.

Areas covered: Overall clinical management in SID patients is primarily guided by systemic symptoms. Cardiovascular disease goes largely undetected, as it evolves through years of a protracted and subclinical course. Despite the increased awareness and insights into the mechanistic role of the inflammatory pathways, clinical management of cardiac involvement continues to rely on diagnostic means, which are frequently insensitive, invasive and rely on radiation exposure. Advanced tissue characterisation with cardiovascular magnetic resonance (CMR) offers an accurate, non-invasive and radiation-free diagnostic method with obvious advantages: it is able to inform on a range of cardiovascular pathophysiology, as well as support safe serial examinations, informing on the disease presence, progress and response to treatment.

Expert commentary: We summarise the recent advances in non-invasive imaging, and bridge the novel insights into pathophysiology with future posibilities in diagnosis and manangement of SID patients. We propose an interdisciplinary framework to screening of cardiac involvement in SID using an indepth phenotyping of evolution of cardiovascular disease, to decipher the opportunities to improve patients’ cardiac care.

KEYWORDS:

• Cardiac magnetic resonance
• systemic inflammatory diseases
• rheumatoid arthritis
• systemic lupus erythematosis
• non-ischaemic cardiomyopathy
• T1 mapping
• T2 mapping
• microvascular disease
• myocarditis
• aortic stiffness

Declaration of interest

V Puntmann and E Nagel hold a patent of invention for a method for differentiation of normal myocardium from diffuse disease using T1-mapping in nonischaemic cardiomyopathies and others (based on PR-MS 33.297, PR-MS 33.837, PR-MS 33.654) (with no financial interest). The Institute of Experimental and Translational Cardiovascular Imaging is supported by the German Ministry of Education and Research via the German Centre for Cardiovascular Research (DZHK) to V Puntmann and E Nagel. E Peker is supported by the Turkish Ministry of Health and Science. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was supported by the Deutsches Zentrum für Herz/Kreislauf.