Abstracto

Cardiovascular magnetic resonance as a treatment guide for cardiac involvement in autoimmune rheumatic diseases.

George Markousis-Mavrogenis, Loukia Koutsogeorgopoulou, Aikaterini Giannakopoulou, Ourania Kariki, Vasiliki Vartela, Sophie I. Mavrogeni

Ventricular tachycardia is not unusual during the course of cardiac involvement in Autoimmune Rheumatic Diseases (ARDs). It may be the result of myocardial inflammation/ischemia, or in rare cases the result of immunosuppressive medication. Our aim in this mini review is to present the existing literature about the role of Cardiovascular Magnetic Resonance (CMR) as a guide for arrhythmia prediction/treatment in ARDs.

CMR has been successfully used for diagnosis and follow up of cardiac involvement. Furthermore, its role in the identification of arrhythmogenic substrate has been extensively studied in non ARDs patients. However, there are only few data about its role in the detection of arrhythmogenic substrate in ARDs. In a recent study, T1/T2-mapping and Extracellular Volume Fraction (ECV) was found to offer incremental value as identifiers of arrhythmogenic substrates in ARD patients, beyond traditionally used indices and can thus guide Implantable Cardiac Defibrillator (ICD) implantation. Additionally, a recent multicenter CMR study showed that T2 ratio and % LGE had the greatest utility as independent predictors of rhythm disturbances in SSc patients. Finally, in a population of sarcoid patients with nonspecific symptoms, the presence of myocardial scar, assessed by LGE, was the best independent predictor of potentially lethal events, as well as other adverse events.

All previous mentioned studies showed that CMR has a great potential as a tool for arrhythmogenic substrate diagnosis and treatment guide in ARDs. However, multicenter studies are still needed to establish its role as a guide for arrhythmogenic substrate detection/treatment in ARDs.