Abstract
The risk of cardiovascular (CV) events and mortality is significantly higher in patients with systemic rheumatic diseases than in the general population. Although CV involvement in such patients is highly heterogeneous and may affect various structures of the heart, it can now be diagnosed earlier and promptly treated. Various types of assessments are employed for the evaluation of CV risk such as transthoracic or transesophageal echocardiography, magnetic resonance imaging (MRI), and computed tomography (CT) to investigate valve abnormalities, pericardial disease, and ventricular wall motion defects. The diameter of coronary arteries can be assessed using invasive quantitative coronarography or intravascular ultrasound, and coronary flow reserve can be assessed using non-invasive transesophageal or transthoracic ultrasonography (US), MRI, CT, or positron emission tomography (PET) after endothelium-dependent vasodilation. Finally, peripheral circulation can be measured invasively using strain-gauge plethysmography in an arm after the arterial infusion of an endothelium-dependent vasodilator or non-invasively by means of US or MRI measurements of flow-mediated vasodilation of the brachial artery. All of the above are reliable methods of investigating CV involvement, but more recently, introduced use of speckle tracking echocardiography and 3-dimensional US are diagnostically more accurate.
Highlights
The risk of cardiovascular (CV) disease due to advanced atherosclerosis is higher in patients with systemic rheumatic diseases (SRDs) even in the absence of traditional CV risk factors [1], occurs earlier than in the general population, and is frequently asymptomatic in its early stages [2]
English-language articles published between January 1995 and July 2017 were found in the PubMed, Medline, and Cochrane Library databases using the key words “cardiovascular diseases” or “atherosclerosis,” “endothelial dysfunction,” “connective tissue disease,” “rheumatologic(al) disease”, “cardiovascular tools,” “non-invasive methods” or “invasive methods, “echocardiography,” and “coronary flow reserve.”
The measurement site is crucial for standardization and reliability but, Common carotid intima-media thickness (ccIMT) assessments are considered to be quantitative, they do not allow detailed ultrastructural analysis of the whole extracranial carotid system [69]: future myocardial and cerebrovascular events can be better predicted on the basis of the presence of plaques in the carotid system or total plaque area than on the basis of ccIMT, but their combination is recommended in asymptomatic adults at intermediate risk of CV events [70]
Summary
The risk of cardiovascular (CV) disease due to advanced atherosclerosis is higher in patients with systemic rheumatic diseases (SRDs) even in the absence of traditional CV risk factors [1], occurs earlier than in the general population, and is frequently asymptomatic in its early stages [2]. Non-invasive tests are the preferred means of investigating suspected or confirmed coronary artery disease (CAD), valve anomalies, and the other morphological and structural changes induced by SRDs [7, 8] (Table 1), but this review will describe invasive methods of diagnosing CV involvement in SRD patients (Table 2). English-language articles published between January 1995 and July 2017 were found in the PubMed, Medline, and Cochrane Library databases using the key words “cardiovascular diseases” or “atherosclerosis,” “endothelial dysfunction,” “connective tissue disease,” “rheumatologic(al) disease” (including “rheumatoid arthritis,” “spondyloarthritis,” “systemic lupus erythematosus,” “Sjögren’s syndrome,” “mixed connective tissue disease,” “vasculitis”), “cardiovascular tools,” “non-invasive methods” or “invasive methods, “echocardiography,” and “coronary flow reserve.”. English-language articles published between January 1995 and July 2017 were found in the PubMed, Medline, and Cochrane Library databases using the key words “cardiovascular diseases” or “atherosclerosis,” “endothelial dysfunction,” “connective tissue disease,” “rheumatologic(al) disease” (including “rheumatoid arthritis,” “spondyloarthritis,” “systemic lupus erythematosus,” “Sjögren’s syndrome,” “mixed connective tissue disease,” “vasculitis”), “cardiovascular tools,” “non-invasive methods” or “invasive methods, “echocardiography,” and “coronary flow reserve.” The articles and book chapters in the papers’ reference lists were reviewed
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