Echocardiography in Autoimmune Rheumatic Diseases for Diagnosis and Prognosis of Cardiovascular Complications

Abstract

Autoimmune rheumatic diseases are systemic diseases frequently affecting the heart and vessels. The main cardiovascular complications are pericarditis, myocarditis, valvular disease, obstructive coronary artery disease and coronary microcirculatory dysfunction, cardiac failure and pulmonary hypertension. Echocardiography, including transthoracic two and three-dimensional echocardiography, Doppler imaging, myocardial deformation and transesophageal echo, is an established and widely available imaging technique for the identification of cardiovascular manifestations that are crucial for prognosis in rheumatic diseases. Echocardiography is also important for monitoring the impact of drug treatment on cardiac function, coronary microcirculatory function, valvular function and pulmonary artery pressures. In this article we summarize established and evolving knowledge on the role of echocardiography for diagnosis and prognosis of cardiovascular abnormalities in rheumatic diseases.

Keywords: autoimmune rheumatic diseases; echocardiography; myocardial deformation; three dimensional echocardiography.

Figure 1

(A) A patient with rheumatoid arthritis and impaired global longitudinal strain (−18.1%). (Β) After treatment with the interleukin-1 inhibitor, global longitudinal strain improved (−22.5%).

Figure 2

A patient with rheumatoid arthritis and impaired coronary flow reserve by Doppler echo. Coronary flow of the left anterior descending artery (LAD) at rest (A) and after adenosine infusion (B). Coronary flow reserve as a maximum diastolic velocity ratio was calculated at 1.5.