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Prospects of using cardiovascular magnetic resonance in the identification of arrhythmogenic substrate in autoimmune rheumatic diseases

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Abstract

Sudden cardiac death (SCD) is due to ventricular tachycardia/fibrillation (VT/VF) and may occur with or without any structural or functional heart disease. The presence of myocardial edema, ischemia and/or fibrosis plays a crucial role in the pathogenesis of VT/VF, irrespective of the pathophysiologic background of the disease. Specifically, in autoimmune rheumatic diseases (ARDs), various entities such as myocardial/vascular inflammation, ischemia and fibrosis may lead to VT/VF. Furthermore, autonomic dysfunction, commonly found in ARDs, may also contribute to SCD in these patients. The only non-invasive, radiation-free imaging modality that can perform functional assessment and tissue characterization is cardiovascular magnetic resonance (CMR). Due to its capability to detect and quantify edema, ischemia and fibrosis in parallel with ventricular function assessment, CMR has the great potential to identify ARD patients at high risk for VT/VF, thus influencing both cardiac and anti-rheumatic treatment and modifying perhaps the criteria for implantation of cardioverter defibrillators.

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Authors and Affiliations

  1. Onassis Cardiac Surgery Center, 50 Esperou Street, 175-61 P. Faliro, Athens, Greece

    Sophie I. Mavrogeni, George Markousis-Mavrogenis, George Poulos, Genovefa Kolovou & George Theodorakis

  2. Joint Rheumatology Programme, National and Kapodistrian University of Athens Medical School, Athens, Greece

    Petros P. Sfikakis

  3. Department of Internal Medicine, Rheumatology, Aristotle University, Thessaloniki, Greece

    Theodoros Dimitroulas

  4. Department of Pathophysiology, Laikon Hospital, Athens, Greece

    Loukia Koutsogeorgopoulou

  5. Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK

    George D. Kitas

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  1. Sophie I. Mavrogeni
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Contributions

SM and GK: concept and writing preparation. GMM: writing preparation. PS, LK and TD: writing on rheumatology. GK, GP and GT: writing on cardiology.

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Correspondence to Sophie I. Mavrogeni.

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Mavrogeni, S.I., Sfikakis, P.P., Dimitroulas, T. et al. Prospects of using cardiovascular magnetic resonance in the identification of arrhythmogenic substrate in autoimmune rheumatic diseases. Rheumatol Int 38, 1615–1621 (2018). https://doi.org/10.1007/s00296-018-4110-5

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