title: Cardiac magnetic resonance imaging reveals frequent myocardial involvement and dysfunction in active rheumatoid arthritis.
abstract: OBJECTIVE
  In rheumatoid arthritis (RA), cardiac involvement is common and often subclinical. We used cardiovascular magnetic resonance (CMR) to identify myocardial abnormalities in patients with active RA, free of clinical cardiac disease.
  
  
  METHODS
  Sixty female patients with active RA aged <70 years and 21 sex- and age-matched control subjects underwent either 1.5T or 3T CMR imaging for analyses of T1 relaxation times, late gadolinium enhancement (LGE), and the volumes, and function of both ventricles.
  
  
  RESULTS
  Determined using 1.5T CMR, the native left ventricular (LV) septal T1 time averaged 1011 (range 973-1046) ms in 20 patients with RA vs. 976 (range 970-988) ms in 10 control subjects (p=0.045). With 3T CMR, the T1 time measured 1173 (range 1154-1187) ms in 29 RA patients vs. 1053 (range 942-1148) ms in 9 control subjects (p=0.002). Myocardial LGE was detected in 55% of the RA patients. LV ejection fraction averaged 58 (range 56-61)% vs. 66 (61-74)% (p<0.001) in the RA (n=60) and control groups (n=21), respectively, and corresponding means for LV peak filling rate were 2.99 (range 2.32-3.33) s-1 vs. 3.39 (range 2.96-3.70) s-1 (p=0.012). The end-diastolic volumes of either ventricle were enlarged in RA compared to the control group (p<0.05 for both).
  
  
  CONCLUSIONS
  In active RA, myocardial T1 relaxation times are prolonged suggesting diffuse inflammation or fibrosis. Local myocardial scars and inflammation, visible as LGE, are also common, as are impairments of LV systo-diastolic function.
authors.affiliation: HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. miia.holmstrom@hus.fi.
authors.forename: Miia
authors.initials: M
authors.lastname: Holmström
authors.affiliation: Department of Rheumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Riitta
authors.initials: R
authors.lastname: Koivuniemi
authors.affiliation: Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Kirsi
authors.initials: K
authors.lastname: Korpi
authors.affiliation: HUS Medical Imaging Center, Clinical Physiology and Nuclear Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Touko
authors.initials: T
authors.lastname: Kaasalainen
authors.affiliation: Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Mika
authors.initials: M
authors.lastname: Laine
authors.affiliation: Department of Bacteriology and Immunology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Kuuliala
authors.affiliation: Department of Rheumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Marjatta
authors.initials: M
authors.lastname: Leirisalo-Repo
authors.affiliation: Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Markku
authors.initials: M
authors.lastname: Kupari
authors.affiliation: HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Sari
authors.initials: S
authors.lastname: Kivistö
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D016022:Case-Control Studies; D003627:Data Interpretation, Statistical; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008875:Middle Aged; D062072:Patient Acuity; D013318:Stroke Volume; D013995:Time; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology