Cardiac involvement in patients with rheumatic disorders: Data of the RHEU-M(A)R study.
BACKGROUND
The diagnosis of cardiac involvement in rheumatic disorders is challenging due to its varying clinical presentation. Since clinical consequences range from immediate treatment changes to adverse long-term outcome, individual risk stratification is of great clinical interest. Primary aim was to evaluate the prevalence of cardiac involvement in patients with different rheumatic disorders using late gadolinium enhancement-cardiac magnetic resonance imaging (LGE-CMR). In addition, we sought to investigate if different rheumatic disorders would demonstrate different LGE patterns.


METHODS
Two-hundred-ninety-seven patients with rheumatic disorders were included and underwent LGE-CMR for work-up of cardiac involvement, which was defined by the presence of LGE in the myocardium. Patients were divided into five subgroups: 1) ANCA-associated vasculitis, 2) non-ANCA-associated vasculitis, 3) connective tissue disorders, 4) arthritis, and 5) sarcoidosis.


RESULTS
Mean ejection fraction in the overall population was 65%, with a mean age of 55yrs. Prevalence of cardiac involvement in the five subgroups were as follows: 54% in the ANCA-associated vasculitis group, 22% in the non-ANCA-associated vasculitis group, 14% in the group with connective tissue disorders, 21% in the arthritis group, and 24% in sarcoid patients. Each of the five subgroups demonstrated a distinct pattern of LGE.


CONCLUSIONS
There is a wide range in the prevalence of cardiac involvement in different rheumatic disorders (54%-14%). Different groups of rheumatic disorders demonstrate different patterns of LGE.


CONCLUSIONS
Primary aim of the study was to evaluate the presence of cardiac involvement in patients with different rheumatic disorders using LGE-CMR. In addition, we sought to investigate if different rheumatic disorders would reveal different LGE patterns. In our 297 patients, the highest prevalence of cardiac involvement was found in patients with ANCA-associated vasculitis (54%), whereas the lowest prevalence was demonstrated in patients with connective tissue disorders (14%). Furthermore, different groups of rheumatic disorders demonstrate distinct patterns of LGE.
Division of Cardiology, Robert-Bosch-Medical Center, Stuttgart, Germany.
Simon
S
Greulich
Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center, Stuttgart, Germany.
Daniel
D
Kitterer
Division of Cardiology, University Hospital (Inselspital), Bern, Switzerland.
Reto
R
Kurmann
Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases, and Department of Internal Medicine II (Oncology, Haematology, Immunology, Rheumatology, Pulmology), University Hospital Tuebingen, Tuebingen, Germany.
Joerg
J
Henes
Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center, Stuttgart, Germany.
Joerg
J
Latus
Division of Cardiology, University Hospital (Inselspital), Bern, Switzerland.
Steffen
S
Gloekler
Division of Cardiology, University Hospital (Inselspital), Bern, Switzerland.
Andreas
A
Wahl
Department of Cardiology, Angiology, and Respiratory Medicine, University Hospital Heidelberg, Heidelberg, Germany.
Sebastian J
SJ
Buss
Department of Cardiology, Angiology, and Respiratory Medicine, University Hospital Heidelberg, Heidelberg, Germany.
Hugo A
HA
Katus
Division of Cardiology, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.
Marco
M
Bobbo
Multimodality Cardiac Imaging Section, Policlinico San Donato, Milan, Italy.
Massimo
M
Lombardi
Division of Radiology, Robert-Bosch-Medical Center, Stuttgart, Germany.
Maik
M
Backes
Division of Cardiology, Robert-Bosch-Medical Center, Stuttgart, Germany.
Hannah
H
Steubing
Division of Cardiology, Robert-Bosch-Medical Center, Stuttgart, Germany.
Pascal
P
Schepat
Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center, Stuttgart, Germany.
Niko
N
Braun
Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center, Stuttgart, Germany.
M Dominik
MD
Alscher
Division of Cardiology, Robert-Bosch-Medical Center, Stuttgart, Germany.
Udo
U
Sechtem
Division of Cardiology, Robert-Bosch-Medical Center, Stuttgart, Germany. Electronic address: Heiko.Mahrholdt@rbk.de.
Heiko
H
Mahrholdt
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D004562:Electrocardiography / Q000639:trends; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000639:trends; D008297:Male; D008875:Middle Aged; D012216:Rheumatic Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D013223:Statistics as Topic / Q000639:trends
CMR; Cardiac involvement; LGE; Patterns; Rheumatic disorders