Abstract
BackgroundMyocardial involvement in AAV patients might be silent, presenting with no or nonspecific symptoms, normal ECG, and preserved left-ventricular ejection fraction (LV-EF). Since up to 50% of deaths in these patients may be due to myocardial involvement, a reliable diagnostic tool is warranted. In contrast to LGE-CMR, which has its strengths in detecting focal inflammatory or fibrotic processes, recent mapping techniques are able to detect even subtle, diffuse inflammatory or fibrotic processes. Our study sought to investigate ANCA (antineutrophil cytoplasmic antibody) associated vasculitides (AAV) patients for myocardial involvement by a cardiovascular magnetic resonance (CMR) protocol, including late gadolinium enhancement (LGE) and mapping sequences.MethodsThirty seven AAV patients were prospectively enrolled and underwent CMR imaging. Twenty healthy volunteers served as controls.ResultsMean LV-EF was 64%; LGE prevalence of the AAV patients was 43%. AAV patients had higher median native T1 (988 vs. 952 ms, p < 0.001), lower post-contrast T1 (488 vs. 524 ms, p = 0.03), expanded extracellular volume (ECV) (27.5 vs. 24.5%, p < 0.001), and higher T2 (53 vs. 49 ms, p < 0.001) compared to controls, with most parameters independent of the LGE status. Native T1 and T2 in AAV patients showed the highest prevalence of abnormally increased values beyond the 95% percentile of controls.ConclusionAAV patients demonstrated increased T1, ECV, and T2 values, with native T1 and T2 showing the highest prevalence of values beyond the 95% percentile of normal. Since these findings seem to be independent of LGE, mapping techniques may provide complementary information to LGE-CMR in the assessment of myocardial involvement in patients with AAV.
Highlights
Myocardial involvement in associated vasculitides (AAV) patients might be silent, presenting with no or nonspecific symptoms, normal ECG, and preserved left-ventricular ejection fraction (LV-Ejection fraction (EF))
Patient population Thirty-seven patients were prospectively enrolled between September 2013 and February 2016 if they fulfilled the following criteria: 1) Diagnosis of Eosinophilic granulomatosis with polyangiitis (EGPA) or Granulomatosis with polyangiitis (GPA) according to the revised Chapel Hill Consensus Conference nomenclature [15]; and 2) no history of Coronary artery disease (CAD), myocardial infarction and/or prior revascularization; and 3) successful cardiovascular magnetic resonance (CMR)
Patient characteristics In total, n = 57 subjects were included in this study (Table 1): n = 37 AAV patients (22 EGPA, 15 GPA), n = 20 controls
Summary
Myocardial involvement in AAV patients might be silent, presenting with no or nonspecific symptoms, normal ECG, and preserved left-ventricular ejection fraction (LV-EF). Our study sought to investigate ANCA (antineutrophil cytoplasmic antibody) associated vasculitides (AAV) patients for myocardial involvement by a cardiovascular magnetic resonance (CMR) protocol, including late gadolinium enhancement (LGE) and mapping sequences. ANCA (antineutrophil cytoplasmic antibody)-associated vasculitides (AAV) comprise different types of autoimmune diseases, in which autoantibodies react to proteinase 3 (PR3), or myeloperoxidase (MPO) [1]. Patients with myocardial involvement may have no or nonspecific symptoms, normal ECG, and preserved left-ventricular ejection fraction (LV-EF) yet they may face life-threatening arrhythmias or endstage heart failure during the course of the disease [4, 5].
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