Abstract
Background: Autoimmune rheumatic diseases (ARDs) may affect both the heart and the brain. However, little is known about the interaction between these organs in ARD patients. We asked whether brain lesions are more frequent in ARD patients with cardiac symptoms compared with non-ARD patients with cardiovascular disease (CVD). Methods: 57 ARD patients with mean age of 48 ± 13 years presenting with shortness of breath, chest pain, and/or palpitations, and 30 age-matched disease-controls with non-autoimmune CVD, were evaluated using combined brain–heart magnetic resonance imaging (MRI) in a 1.5T system. Results: 52 (91%) ARD patients and 16 (53%) controls had white matter hyperintensities (p < 0.001) in at least one brain area (subcortical/deep/periventricular white matter, basal ganglia, pons, brainstem, or mesial temporal lobe). Only the frequency and number of subcortical and deep white matter lesions were significantly greater in ARD patients (p < 0.001 and 0.014, respectively). ARD vs. control status was the only independent predictor of having any brain lesion. Specifically for deep white matter lesions, each increase in ECV independently predicted a higher number of lesions [odds ratio (95% confidence interval): 1.16 (1.01–1.33), p = 0.031] in ordered logistic regression. Penalized logistic regression selected only ARD vs. control status as the most important feature for predicting whether brain lesions were present on brain MRI (odds ratio: 5.46, marginal false discovery rate = 0.011). Conclusions: Subclinical brain involvement was highly prevalent in this cohort of ARD patients and was mostly independent of the severity of cardiac involvement. However, further research is required to determine the clinical relevance of these findings.
Highlights
In recent years, a paradigm of recognizing the interactions between cardiac pathologies and other organ systems has gradually developed
The primary aim of this study was to perform a combined heart/brain magnetic resonance imaging (MRI) study of Autoimmune rheumatic diseases (ARDs) patients presenting with cardiac symptoms and matched disease controls with non-autoimmune cardiovascular disease (CVD), in order to compare the prevalence of white matter hyperintensities (WMHs) in both groups and to investigate potential associations between WMH burden and the severity of cardiac dysfunction based on MRI indices
We report for the first time a comparison of the prevalence of WMH in ARD patients and disease controls with CVD
Summary
A paradigm of recognizing the interactions between cardiac pathologies and other organ systems has gradually developed. In this context, entities in the form of the cardiorenal and cardiohepatic syndromes [1], as well as the important interplay between cardiovascular disease and the immune system [2] have attracted significant scientific attention. The logical step in this paradigm is the interaction between the brain and the heart in health and disease These two organs share significant anatomical similarity in their vascular anatomy and organization, with both relying on deep penetrating arteries arising from conduit arteries on their surface for tissue perfusion. Further research is required to determine the clinical relevance of these findings
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