title: Myopericarditis, as the first sign of rheumatoid arthritis relapse, evaluated by cardiac magnetic resonance.
abstract: BACKGROUND
  Rheumatoid arthritis (RA) affects many organs, including the heart. Cardiac magnetic resonance (CMR) can assess heart pathophysiology in RA.
  
  
  OBJECTIVE
  To evaluate, using CMR, RA patients under remission with recent onset of cardiac symptoms.
  
  
  METHODS
  Twenty RA under remission (15F/5M), aged 60±5 yrs, with recent onset of cardiac symptoms (RAH), were prospectively evaluated by CMR. The CMR included left ventricular ejection fraction (LVEF), T2-weighted (T2-W), early (EGE) and late gadolinium enhanced (LGE) images evaluation. Their results were compared with those of 20 RA under remission without cardiac symptoms (RAC) and 18 with systemic lupus erythematosus (SLE) with clinically overt myocarditis.
  
  
  RESULTS
  Cardiac enzymes were abnormal in 5/20 RAH. CMR revealed inferior wall myocardial infarction in 2/20 (1M, 1F) and myocarditis in 13/20 (8M/5F) RAH. The T2 ratio of myocardium to skeletal muscle was increased in RAH and SLE compared to RAC (2.5 ± 0.05 and 3.4±0.7 vs 1.8 ± 0.5, p<0.001). EGE was increased in RAH and SLE compared to RAC (15 ± 3 and 12±4.7 vs 2.7±0.8, p<0.001). Epicardial LGEs were identified in 10/13 and pericarditis in 6/13 RAH. Coronary angiography, performed in 5 RAH with increased cardiac enzymes, proved a right coronary artery obstruction in 2/5. In 3/5 with CMR positive for myocarditis, coronary arteries were normal, but endomyocardial biopsy revealed inflammation with normal PCR. An RA relapse was observed after 7-40 days in 10/13 RAH with myopericarditis. The one year follow up showed that a) RAH with myocarditis had more disease relapses and b) CHF was developed in 4 RAH with myocarditis.
  
  
  CONCLUSIONS
  Myopericarditis with atypical presentation, diagnosed by CMR in RA under remission, may precede the development of RA relapse. In 1 year follow up, RA patients with history of myocarditis have a higher frequency of disease relapse and may develop CHF.
authors.affiliation: Onassis Cardiac Surgery Center, Athens, Greece. soma13@otenet.gr
authors.forename: Sophie
authors.initials: S
authors.lastname: Mavrogeni
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Bratis
authors.forename: Eliza
authors.initials: E
authors.lastname: Sfendouraki
authors.forename: Evangelia
authors.initials: E
authors.lastname: Papadopoulou
authors.forename: Genovefa
authors.initials: G
authors.lastname: Kolovou
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000175:diagnosis* / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology; D010493:Pericarditis / Q000175:diagnosis* / Q000503:physiopathology; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012008:Recurrence