Involvement In Systemic Inflammatory Diseases Research Articles

Novel Imaging Approaches toCardiacManifestations of SystemicInflammatoryDiseases: JACC Scientific Statement.

Derangements in the innate and adaptive immune responses observed in systemic inflammatory syndromes contributes to unique elevated atherosclerotic risk and incident cardiovascular disease. Novel multimodality imaging techniques may improve diagnostic precision for the screening and monitoring of disease activity. The integrated application of these technologies lead to earlier diagnosis and noninvasive monitoring of cardiac involvement in systemic inflammatory diseases that will aid in preclinical studies, enhance patient selection, and provide surrogate endpoints in clinical trials, thereby improving clinical outcomes. We review the common cardiovascular manifestations of immune-mediated systemic inflammatory diseases and address the clinical and investigational role of advanced multimodality cardiac imaging.

Cardiac Diseases During Systemic Inflammatory Diseases in the Internal Medicine and Medical Oncology Department of NTHC-HKM of Cotonou

Systemic inflammatory diseases are characterized by multivisceral involvement at some point in their evolution. This involvement can concern almost all organs, including the heart. Each systemic condition has a unique cardiac expression. The target of this study is to determine the frequency of cardiac involvement in systemic inflammatory diseases. This study is a cross-sectional, descriptive, and analytical study that was conducted within 07 months. The aim was to screen 23 patients followed for systemic inflammatory diseases for cardiac involvement. The mean age was 44 (±12) years old with a minimum of 24 and a maximum 64 years. Most of patients were women with a sex ratio (M/F) of 0.09. An echocardiographic abnormality was found in 26.1% of patients and 73.1% had an ECG abnormality. They included left atrial hypertrophy (43.4%), left ventricular hypertrophy (30.4%), right axial deviation (26.1%), low voltage (21.7%), right atrial hypertrophy (8.6%), S1Q3 appearance (8, 6%), pulmonary hypertension (8.6%), repolarization disorders (8.6%), sinus tachycardia (8.6%), middle tricuspid insufficiency (4.3%), middle pulmonary insufficiency (4.3%), and pericarditis (4.3%). Patients with systemic inflammatory diseases had cardiac disorders with rare clinical manifestations but with an incidental discovery either on ECG or on cardiac echodoppler. Hence, a systematic cardiac exploration in these patients was essential.

Cardiac Diseases During Systemic Inflammatory Diseases in the Internal Medicine and Medical Oncology Department of NTHC-HKM of Cotonou

Systemic inflammatory diseases are characterized by multivisceral involvement at some point in their evolution. This involvement can concern almost all organs, including the heart. Each systemic condition has a unique cardiac expression. The target of this study is to determine the frequency of cardiac involvement in systemic inflammatory diseases. This study is a cross-sectional, descriptive, and analytical study that was conducted within 07 months. The aim was to screen 23 patients followed for systemic inflammatory diseases for cardiac involvement. The mean age was 44 (±12) years old with a minimum of 24 and a maximum 64 years. Most of patients were women with a sex ratio (M/F) of 0.09. An echocardiographic abnormality was found in 26.1% of patients and 73.1% had an ECG abnormality. They included left atrial hypertrophy (43.4%), left ventricular hypertrophy (30.4%), right axial deviation (26.1%), low voltage (21.7%), right atrial hypertrophy (8.6%), S1Q3 appearance (8, 6%), pulmonary hypertension (8.6%), repolarization disorders (8.6%), sinus tachycardia (8.6%), middle tricuspid insufficiency (4.3%), middle pulmonary insufficiency (4.3%), and pericarditis (4.3%). Patients with systemic inflammatory diseases had cardiac disorders with rare clinical manifestations but with an incidental discovery either on ECG or on cardiac echodoppler. Hence, a systematic cardiac exploration in these patients was essential.

Cardiac Diseases During Systemic Inflammatory Diseases in the Internal Medicine and Medical Oncology Department of NTHC-HKM of Cotonou

Systemic inflammatory diseases are characterized by multivisceral involvement at some point in their evolution. This involvement can concern almost all organs, including the heart. Each systemic condition has a unique cardiac expression. The target of this study is to determine the frequency of cardiac involvement in systemic inflammatory diseases. This study is a cross-sectional, descriptive, and analytical study that was conducted within 07 months. The aim was to screen 23 patients followed for systemic inflammatory diseases for cardiac involvement. The mean age was 44 (±12) years old with a minimum of 24 and a maximum 64 years. Most of patients were women with a sex ratio (M/F) of 0.09. An echocardiographic abnormality was found in 26.1% of patients and 73.1% had an ECG abnormality. They included left atrial hypertrophy (43.4%), left ventricular hypertrophy (30.4%), right axial deviation (26.1%), low voltage (21.7%), right atrial hypertrophy (8.6%), S1Q3 appearance (8, 6%), pulmonary hypertension (8.6%), repolarization disorders (8.6%), sinus tachycardia (8.6%), middle tricuspid insufficiency (4.3%), middle pulmonary insufficiency (4.3%), and pericarditis (4.3%). Patients with systemic inflammatory diseases had cardiac disorders with rare clinical manifestations but with an incidental discovery either on ECG or on cardiac echodoppler. Hence, a systematic cardiac exploration in these patients was essential.

Update Myocarditis

Myocarditis is a heterogenous disease regarding aetiology, clinical presentation and course. A defined diagnostic procedure is needed to reliably detect myocarditis. While findings from medical laboratory parameters, electrocardiography and echocardiography are rather unspecific, endomyocardial biopsies supply dependable data regarding inflammatory and viral status. Analysis of cardiac MR is constantly being improved in order to increase sensitivity regarding myocarditis detection. Incidence, clinical presentation as well as disease progression and prognosis show considerable gender differences. Adamant implementation of defined diagnostic procedures is needed in order not to overlook myocarditis in women while the understanding of the pathomechanisms behind the gender differences might lead the way to new therapeutic options. Currently, treatment of myocarditis symptoms and heart failure is in the focus of clinical care. In addition, cardiac involvement in systemic inflammatory diseases should be stringently treated via immunosuppression. Avoidance of physical exercise has to be observed in order to reduce cardiac strain and consequently the number of adverse events.

Towards the Clinical Management of Cardiac Involvement in Systemic Inflammatory Conditions—a Central Role for CMR

Anti-inflammatory therapies in systemic inflammatory diseases (SID) improve disease-associated disability and may also reduce cardiovascular events. Further optimization of treatment to directly target the inflammation affecting the cardiovascular system represents a potential goal of contemporary treatment. Yet, lack of non-invasive means to detect cardiovascular involvement and to monitor the response to treatment limit such advancements. This is also reflected in the recent 2017 ESC position paper on clinical management of cardiac involvement in SIDs, whose recommendations continue to rely on insensitive, radiation-heavy and invasive diagnostic methods. Absence of evidence and the context of a life-long chronic disease, necessitating ongoing monitoring and serial assessments, puts such recommendations in question. The growing evidence-base for the performance of cardiovascular magnetic resonance (CMR) in patients with SID, and especially of T1 and T2 mapping, offers a viable pathway towards identification of cardiovascular involvement and may potentially guide cardiovascular-specific therapies. In this review, we appraise the current evidence for the role of CMR in management of cardiac involvement patients with SID. We propose an interdisciplinary framework with a central role for CMR to support the clinical management of cardiac involvement in SID patients.

Is there a place for cardiovascular magnetic resonance conditional devices in systemic inflammatory diseases?

ABSTRACTRhythm disturbances and sudden cardiac death (SCD) are important manifestations of cardiac involvement in systemic inflammatory diseases (SID). The commonest events demanding the implantation of a device include ventricular tachycardia and atrioventricular block, mainly diagnosed in sarcoidosis, systemic lupus erythematosus and scleroderma. In SCD, cardiac magnetic resonance (CMR) identified areas of late gadolinium enhancement (LGE) in 71% and provided an arrhythmic substrate in 76%, while during the follow-up, the extent of LGE identified a subgroup at increased risk for future adverse events. CMR has been successfully used for detection of cardiac disease in SID, including myocarditis, coronary, microvascular and valvular disease. Additionally, SIDs have a higher probability to need MRI scanning of other organs, due to their systemic disease. These reasons support the necessity of an MRI conditional device in SIDs. A broad selection of devices, approved for the MRI environment under defined conditions allows the safe and accurate scanning of SID patients.

Corneal involvement in systemic inflammatory diseases.

Corneal involvement in patients with systemic inflammatory disorders may be sight threatening, and it may be associated with a life-threatening disease. Significant systemic inflammatory diseases in this context are autoimmune connective tissue diseases, systemic autoimmune dermatological disorders, and autoimmune diseases of the lacrimal system. Keratoconjunctivitis sicca is usually the most common ocular finding in these patients. Peripheral ulcerative keratitis is a rare condition usually associated with increased ocular morbidity and also mortality, as it might act as an indicator of a more widespread vasculitis. Corneal biomechanical properties may also be altered in connective tissue diseases. Although recent studies suggest that the risk for corneal complications after ocular surgery in patients with quiescent autoimmune disease is minimal, caution is still recommended, as the knowledge about the corneal wound-healing process and the corneal biomechanical properties in these patients is not yet fully understood. This article reviews corneal abnormalities and characteristics in the setting of systemic inflammatory diseases.

Deciphering Cardiovascular Disease in Systemic Inflammatory Diseases Using Advanced Magnetic Resonance Imaging

Cardiovascular involvement in systemic inflammatory diseases (SID) is underestimated despite its high mortality and morbidity. SID with cardiovascular involvement includes rheumatoid arthritis and the spondyloarthropathies, systemic lupus erythematosus, systemic vasculitides, inflammatory myopathies, systemic sclerosis, mixed connective tissue diseases (MCTD) and sarcoidosis (SRC). Cardiovascular magnetic resonance (CMR) is of great value in SID because myocardial inflammation, diffuse, subendocardial vasculitis and small scars due to inflammation or myocardial infarction and heart disease acuity can be detected neither by echocardiography nor by nuclear techniques; finally, most patients are unable to exercise adequately, and pharmacologic stress CMR is the best technique for coronary artery and cardiac microvascular disease assessment. However, lack of availability, expertise and high cost constitute serious obstacles for the routine application of CMR in every day practice.

Cardiovascular risk in systemic inflammatory diseases

Systemic inflammatory diseases are associated with increased cardiovascular morbidity and mortality. The link between inflammatory and cardiovascular diseases can be attributed to the coexistence of classical risk factors and inflammatory mechanisms activated during systemic inflammatory diseases involving the immune system. Unfavorable metabolic effects of anti-inflammatory drugs can also contribute to increase cardiovascular risk. Yet, clinical implications of these findings are not entirely clear, and deeper knowledge and awareness of cardiac involvement in inflammatory diseases are necessary. The aim of this review is to summarize cardiac involvement in systemic inflammatory diseases and to identify aspects where evidence is currently lacking that would deserve further investigation in the future.

Spectrum of pericardial disease: part II

Pericardial disease is a common disorder seen in varying clinical settings, and may be the first manifestation of an underlying systemic disease. In part I, we focused on the current knowledge and management of the more common pericardial diseases: acute pericarditis, pericardial effusion, cardiac tamponade, chronic pericarditis and relapsing pericarditis. In part II, we will focus on the knowledge and management of pericardial involvement in chylous pericardial effusion cholesterol pericarditis, radiation pericarditis, pericardial involvement in systemic inflammatory diseases, autoreactive pericarditis, pericarditis in renal failure, pericardial constriction and effusive constrictive pericarditis.

Cardiac involvement in systemic inflammatory diseases

Systemic inflammatory diseases represent a large group of rare diseases that may involve all organs and also the heart. The three layers of the heart can be affected and some manifestations such as pericarditis in systemic lupus erythematosus are rather well known, yet others are not known even for cardiologists. Modern sophisticated imaging techniques reveal cardiac abnormalities in most of these diseases and the reported frequency of cardiac involvement ranges widely depending upon the applied diagnostic methods and selection of patients. The clinical significance of these findings is not always established. However, better knowledge and awareness of cardiac involvement is necessary because it conveys a major risk for mortality in several of these rare diseases.