title: Evaluation of myocardial involvement in patients with connective tissue disorders: a multi-parametric cardiovascular magnetic resonance study.
abstract: BACKGROUND
  Severe arrhythmias or heart failure may be surrogates of myocardial involvement in patients with connective tissue disorders (CTD). However, most patients present with unspecific symptoms, normal ECG, and preserved left ventricular ejection fraction (LV-EF). Therefore, timely diagnosis by an accurate technique is crucial. Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) has proven value for the detection of focal processes, but due to the often diffuse character of fibrosis/inflammation in CTD patients, CMR mapping techniques might be of incremental value for the assessment of myocardial involvement. Purpose of this study was to evaluate a multi-parametric CMR protocol as a screening tool for myocardial involvement in CTD patients.
  
  
  METHODS
  Forty CTD patients were prospectively enrolled and underwent CMR, twenty healthy volunteers served as control group.
  
  
  RESULTS
  Mean LV-EF was 62 %; LGE prevalence was low (18 %). CTD patients had higher native T1 (1008 vs. 962 ms, p = 0.001), lower post contrast T1 (494 vs. 526 ms, p = 0.008), expanded extracellular volume (ECV) (28 vs. 25 %, p = 0.001), and higher T2 values (53 vs. 49 ms, p < 0.001) compared to controls. Among patients with values higher than the 95 % percentile of healthy controls, native T1 and T2 values seem to be the most promising discriminators.
  
  
  CONCLUSIONS
  CTD patients showed higher T1, ECV, and T2 values compared to controls, with most significant differences for native T1 and T2, which seem to be independent of the presence of LGE. Our data suggest that CMR mapping techniques are of incremental value in the detection of myocardial involvement in CTD patients.
authors.affiliation: Division of Radiology, University Hospital Innsbruck, Innsbruck, Austria.
authors.forename: Agnes
authors.initials: A
authors.lastname: Mayr
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center Stuttgart, Stuttgart, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kitterer
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center Stuttgart, Stuttgart, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Latus
authors.affiliation: Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376, Stuttgart, Germany.
authors.forename: Hannah
authors.initials: H
authors.lastname: Steubing
authors.affiliation: 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.
authors.forename: Joerg
authors.initials: J
authors.lastname: Henes
authors.affiliation: Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376, Stuttgart, Germany.
authors.forename: Francesco
authors.initials: F
authors.lastname: Vecchio
authors.affiliation: Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376, Stuttgart, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Kaesemann
authors.affiliation: Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376, Stuttgart, Germany.
authors.forename: Alexandru
authors.initials: A
authors.lastname: Patrascu
authors.affiliation: Siemens Healthcare GmbH, Erlangen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Greiser
authors.affiliation: Siemens Healthcare GmbH, Erlangen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Groeninger
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center Stuttgart, Stuttgart, Germany.
authors.forename: Niko
authors.initials: N
authors.lastname: Braun
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center Stuttgart, Stuttgart, Germany.
authors.forename: M Dominik
authors.initials: MD
authors.lastname: Alscher
authors.affiliation: Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376, Stuttgart, Germany.
authors.forename: Udo
authors.initials: U
authors.lastname: Sechtem
authors.affiliation: Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376, Stuttgart, Germany. heiko.mahrholdt@rbk.de.
authors.forename: Heiko
authors.initials: H
authors.lastname: Mahrholdt
authors.affiliation: Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376, Stuttgart, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Greulich
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003240:Connective Tissue Diseases / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005355:Fibrosis; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013318:Stroke Volume; D016277:Ventricular Function, Left
keywords: CMR; Connective tissue disorders; LGE; Mapping; Myocardial involvement