title: Cardiovascular magnetic resonance imaging in asymptomatic patients with connective tissue disease and recent onset left bundle branch block.
abstract: OBJECTIVE
  Recent LBBB in connective tissue diseases (CTDs) is challenging, due to high incidence of underlying pathology that may remain undetected, due to limitations of imaging tests. We hypothesized that cardiovascular magnetic resonance (CMR) may be of diagnostic value in CTDs with recent LBBB and normal echocardiogram.
  
  
  METHODS
  26 CTDs, aged 32 ± 7 yrs (19 F) and 26 controls without CTDs, aged 60 ± 4 yrs (10 F) with recent LBBB and normal echo were evaluated by CMR. The CTDs included 6 sarcoidosis (SRC), 4 systemic sclerosis (SSc), 6 systemic lupus erythematosus (SLE), 6 rheumatoid arthritis (RA) and 4 inflammatory myopathies (IM). CMR was performed by 1.5T. LVEF, T2 ratio (oedema imaging) and late gadolinium enhancement (LGE) (fibrosis imaging) were evaluated. Acute and chronic lesions were characterised by T2>2 and positive LGE and T2<2 and positive LGE, respectively. According to LGE, lesions were characterised as diffuse subendo-, subepicardial/intramural not following and subendocardial/transmural following the distribution of coronaries, indicative of vasculitis, myocarditis and myocardial infarction, respectively.
  
  
  RESULTS
  CTDs were younger (p<0.001), with higher incidence of abnormal CMR (42.31 vs 30.77%, p=NS), including dilated cardiomyopathy (11.54%), diffuse subendocardial fibrosis (11.54%), myocardial infarction (7.69%) and acute myocarditis (11.54%) vs dilated cardiomyopathy (19.23%), myocardial infarction (7.69%) and acute myocarditis (3.85%), detected in non-CTDs.
  
  
  CONCLUSIONS
  In CTDs with recent LBBB, CMR documented acute and chronic cardiac pathology, particularly myocarditis. CMR should be considered as an adjunct to conventional diagnostic workup in both patient groups, more so in CTDs.
authors: Onassis Cardiac Surgery Center, Athens, Greece. Electronic address: soma13@otenet.gr.
authors: Sophie
authors: S
authors: Mavrogeni
authors: Rheumatology Unit, First Department of Propeudeutic and Internal Medicine, Laikon Hospital, Athens University Medical School, Athens, Greece.
authors: Petros P
authors: PP
authors: Sfikakis
authors: Athens Naval Hospital, Athens, Greece.
authors: Georgia
authors: G
authors: Karabela
authors: Athens Naval Hospital, Athens, Greece.
authors: Efthymios
authors: E
authors: Stavropoulos
authors: Athens Naval Hospital, Athens, Greece.
authors: Georgios
authors: G
authors: Spiliotis
authors: Bioiatriki MRI Unit, Athens, Greece.
authors: Elias
authors: E
authors: Gialafos
authors: Rheumatology Unit, First Department of Propeudeutic and Internal Medicine, Laikon Hospital, Athens University Medical School, Athens, Greece.
authors: Stylianos
authors: S
authors: Panopoulos
authors: Rheumatology Unit, First Department of Propeudeutic and Internal Medicine, Laikon Hospital, Athens University Medical School, Athens, Greece.
authors: Vasiliki
authors: V
authors: Bournia
authors: Onassis Cardiac Surgery Center, Athens, Greece.
authors: Dionisia
authors: D
authors: Manolopoulou
authors: Onassis Cardiac Surgery Center, Athens, Greece.
authors: Genovefa
authors: G
authors: Kolovou
authors: Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK.
authors: George
authors: G
authors: Kitas
mesh_terms: D000328:Adult; D058070:Asymptomatic Diseases / Q000453:epidemiology*; D002037:Bundle-Branch Block / Q000175:diagnosis* / Q000453:epidemiology*; D003240:Connective Tissue Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: Cardiovascular magnetic resonance; Connective tissue diseases; LBBB; Myocardial infarction; Myocarditis; Vasculitis