Cardiovascular magnetic resonance imaging pattern at the time of diagnosis of treatment naive patients with connective tissue diseases
Cardiovascular magnetic resonance imaging pattern at the time of diagnosis of treatment naive patients with connective tissue diseases
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DOI：
10.1016/j.ijcard.2017.01.104
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发表时间：
2017-06-01
影响因子：
3.5
通讯作者：
Kolovou, Genovefa
中科院分区：
文献类型：
--
作者：
Mavrogeni, Sophie;Markousis-Mavrogenis, George;Kolovou, Genovefa
背景-目的：超声心动图诊断结缔组织病（CTD）时的心脏受累已被描述。我们假设心血管磁共振（CMR）在CTD诊断中检测到隐匿性病变。78例初治CTD在诊断后早期进行CMR（年龄43 +/-11，59 F/19 M），无心脏受累[5例大动脉炎（TA），4例Churg Strauss综合征（CSS），5例韦格纳肉芽肿（WG），16例系统性红斑狼疮（SLE），类风湿性关节炎（RA）12例，混合性结缔组织病（MCTD）8例，强直性脊柱炎（AS）12例，风湿性多肌痛（PMR）3例，系统性硬化症（SSc）8例，皮肌炎（DM）5例。急性和慢性病变分别以T2> 2和T2 <2为标准。在3/5例TA、3/4例CSS、4/5例WG、10/16例SLE、9/12例RA、6/8例MCTD、4/12例AS、1/3例PMR、2/8例SSc和2/5例DM中，T2比值高于正常值（2.78 ± 0.25 vs 1.5 ± 0.2，p <0.01）。1例TA、1例SLE、1例RA、1例SSc和2例DM患者发生心肌炎，1例CSS和1例RA患者发生弥漫性心内膜下纤维化，3例SLE、1例MCTD、1例PMR和2例RA患者发生心内膜下心肌梗死。在风湿性和心脏治疗6个月和12个月后，对T2比值增加的28/52例CTD进行CMR重新评估，结果显示T2比值显著改善（p <0.001），LGE范围无显著变化，左室功能受损者恢复正常。隐性CMR病变，包括水肿、心肌炎，弥漫性内膜下纤维化和心肌梗死在初治CTD中并不少见，适当治疗可逆转。(C)2017爱思唯尔B.V.保留所有权利。
Background-aim: Cardiac involvement at diagnosis of connective tissue disease (CTD) has been described by echocardiography. We hypothesized that cardio-vascular magnetic resonance (CMR) detects occult lesions at CTD diagnosis.Patients-methods: CMRwas performed early after diagnosis in 78 treatment-nave CTDs (aged 43 +/- 11, 59F/19M) without cardiac involvement [5 Takayasu arteritis (TA), 4 Churg Strauss syndrome (CSS), 5Wegener granulomatosis (WG), 16 systemic lupus erythematosus (SLE), 12 rheumatoid arthritis (RA), 8mixed connective tissue diseases (MCTD), 12 ankylosing spondylitis (AS), 3 polymyalgia rheumatica (PMR), 8 systemic sclerosis (SSc) and 5 dermatomyositis (DM)]. Acute and chronic lesionswere assessed by T2 > 2with positive LGE and T2 < 2withpositive LGE, respectively.Results: In 3/5 TA, 3/4 CSS, 4/5 WG, 10/16 SLE, 9/12 RA, 6/8MCTD, 4/12 AS, 1/3 PMR, 2/8 SSc and 2/5 DM, the T2 ratio was higher compared to normal (2.78 +/- 0.25 vs 1.5 +/- 0.2, p < 0.01). Myocarditis was identified in 1 TA, 1 SLE, 1 RA, 1 SSc and 2 DM patients; diffuse, subendocardial fibrosis in 1 CSS and 1 RA patient, while subendocardialmyocardial infarction in 3 SLE, 1MCTD, 1 PMR and 2 RA patients. CMR re-evaluation after 6 and 12months of rheumatic and cardiac treatment, available in 28/52 CTDs with increased T2 ratio, showed significant improvement in T2 ratio (p < 0.001), non-significant change in LGE extent and normalisation of those with impaired LV function.Conclusions: Occult CMR lesions, including oedema, myocarditis, diffuse subendocardial fibrosis and myocardial infarction are not unusual in treatment nave CTDs and may be reversed with appropriate treatment. (C) 2017 Elsevier B.V. All rights reserved.