The Role of Cardiovascular Magnetic Resonance in Inflammatory Arthropathies and Systemic Rheumatic Diseases

Abstract

In this review, the role of cardiovascular magnetic resonance (CMR), magnetic resonance angiography (MRA) and magnetic resonance spectroscopy (MRS) in the diagnosis, risk stratification, management and prognostication of inflammatory arthropathies and systemic rheumatic diseases (IASRD) is discussed. There have been several recent publications and it is timely to place into perspective the rapidly evolving concepts of advanced imaging in IASRDs through review and critical appraisal of the literature. IASRD are multisystemic autoimmune disorders with predilection for cardiovascular involvement and complications. Persons with IASRD have increased risk of coronary artery disease, stroke, peripheral vascular disease, myocarditis, cardiomyopathy and heart failure that may not be fully explained by traditional CVD risk factors, and inflammation is presumed to be an important determinant of CVD. There is increasing evidence that lowering systemic inflammation reduces prevalence of CVD in IASRD patients. CMR is an advanced imaging modality, free of ionising radiation, with high spatial and temporal resolution, performed via excitation of atomic nuclei with uneven spin and capable of providing detailed anatomical, functional and haemodynamic information on the heart and vasculature. CMR is the single imaging modality capable of assessing noninvasively global and regional cardiac function, fibrosis, perfusion, flow, vascular function and oedema. The unique strengths of CMR are its ability to noninvasively image the entire cardiovascular tree (myocardium and vessels) with high resolution and to reveal tissue characteristics for the study of inflammation, infarction, fibrosis and infiltration. CMR combined with MRA is capable of visualising vascular complications of IASRD as well as to track disease progression or regression following therapy. MRS reported no abnormalities in IASRD on proton MRS, but impaired myocardial energetics on phosphorous MRS. CMR, MRA and MRS have significantly improved our understanding of disease mechanisms, diagnosis, risk stratification, management and prognostication of IASRD. Further CMR can be used for the study of inflammation and fibrosis and to track disease progression and regression following therapeutic interventions.