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Review
. 2023 Oct 12;24(10):290.
doi: 10.31083/j.rcm2410290. eCollection 2023 Oct.

Cardiovascular Magnetic Resonance for the Evaluation of Arrhythmogenic Substrates in Patients with Systemic Autoimmunity: An Update

George Markousis-Mavrogenis  1 , Petros P Sfikakis  2 , Anne Hui Sze Kwong  3 , Alessia Pepe  4 , Marco Matucci-Cerinic  5   6 , George D Kitas  7 , Sophie I Mavrogeni  1   8
Affiliations
Review

Cardiovascular Magnetic Resonance for the Evaluation of Arrhythmogenic Substrates in Patients with Systemic Autoimmunity: An Update

George Markousis-Mavrogenis et al. Rev Cardiovasc Med. .

Abstract

Patients with systemic autoimmunity due to autoimmune rheumatic diseases (ARDs) or sarcoidosis frequently present with systemic manifestations including cardiac involvement. Cardiac rhythm disturbances and specifically ventricular arrhythmias (VAs) may affect the prognosis of these patients. Cardiovascular magnetic resonance imaging (CMR) is a non-invasive imaging modality that can provide valuable diagnostic and prognostic information in patients with ARDs or systemic autoimmunity in general. In this narrative review, we briefly present the underlying pathophysiologic mechanisms contributing to arrhythmogenicity in patients with systemic autoimmunity. Furthermore, we discuss recent advances underlying the role and value of CMR for use in the detection and risk stratification of arrhythmogenic substrates in patients with systemic autoimmunity and VAs.

Keywords: autoimmune disease; cardiovascular disease; fibrosis; inflammation; ischemia; oedema.

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Conflict of interest statement

The authors declare no conflict of interest. Sophie I. Mavrogeni is serving as Guest Editor and Editorial Board of this journal. We declare that Sophie I. Mavrogeni had no involvement in the peer review of this article and has no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to Zhonghua Sun.

Figures

Fig. 1.
Fig. 1.
Biventricular function assessment. Short axis SSFP for function assessment in a patient with systemic sclerosis and pulmonary hypertension. Dilation of the right ventricle with flattening of the interventricular septum due to pulmonary hypertension can be observed. SSFP, steady-state free precession.
Fig. 2.
Fig. 2.
Stress CMR perfusion. Adenosine stress perfusion CMR showing a perfusion defect in the inferolateral wall in a patient with systemic sclerosis and ventricular arrhythmias. CMR, cardiovascular magnetic resonance imaging.
Fig. 3.
Fig. 3.
CMR oedema evaluation using STIRT2. STIRT2 image with diffuse oedema (interventricular septum, anterior and inferior wall) in a patient with systemic lupus erythematosus myocarditis and ventricular arrhythmias (T2 ratio = 4, normal values <2). STIRT2, short tau inversion recovery; CMR, cardiovascular magnetic resonance imaging.
Fig. 4.
Fig. 4.
CMR oedema evaluation using parametric imaging. T2 mapping in patient with polymyositis and ventricular arrhythmias (T2 mapping = 62 msec, normal values <50 msec). CMR, cardiovascular magnetic resonance imaging.
Fig. 5.
Fig. 5.
Replacement fibrosis evaluation using late gadolinium enhancement. Short axis with extensive late gadolinium enhancement (interventricular septum, anterior wall, inferior wall) in a patient with polymyositis and ventricular arrhythmias.
Fig. 6.
Fig. 6.
Scar characterization. Scar characterization using the ADAS software (v5.11, Galgo Medical, Barcelona, Spain) showing the presence of grey area and scar corridors. Cardiac scar is red, border zone is green-yellow and healthy tissue is blue.
Fig. 7.
Fig. 7.
Subendocardial diffuse fibrosis. Diffuse subendocardial late gadolinium enhancement in a patient with systemic sclerosis and ventricular arrhythmias.
Fig. 8.
Fig. 8.
Detection of microfibrosis using T1 mapping. T1 mapping in patient with polymyositis and ventricular arrhythmias (T1 map = 1400 ms, normal values <1250 ms).
See this image and copyright information in PMC

References

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