title: Cardiovascular magnetic resonance imaging pattern at the time of diagnosis of treatment naïve patients with connective tissue diseases.
abstract: OBJECTIVE
  Cardiac involvement at diagnosis of connective tissue disease (CTD) has been described by echocardiography. We hypothesized that cardio-vascular magnetic resonance (CMR) detects occult lesions at CTD diagnosis.
  
  
  METHODS
  CMR was performed early after diagnosis in 78 treatment-naïve CTDs (aged 43±11, 59F/19M) without cardiac involvement [5 Takayasu arteritis (TA), 4 Churg Strauss syndrome (CSS), 5 Wegener granulomatosis (WG), 16 systemic lupus erythematosus (SLE), 12 rheumatoid arthritis (RA), 8 mixed connective tissue diseases (MCTD), 12 ankylosing spondylitis (AS), 3 polymyalgia rheumatica (PMR), 8 systemic sclerosis (SSc) and 5 dermatomyositis (DM)]. Acute and chronic lesions were assessed by T2>2 with positive LGE and T2<2 with positive LGE, respectively.
  
  
  RESULTS
  In 3/5 TA, 3/4 CSS, 4/5 WG, 10/16 SLE, 9/12 RA, 6/8 MCTD, 4/12 AS, 1/3 PMR, 2/8 SSc and 2/5 DM, the T2 ratio was higher compared to normal (2.78±0.25 vs 1.5±0.2, p<0.01). Myocarditis was identified in 1 TA, 1 SLE, 1 RA, 1 SSc and 2 DM patients; diffuse, subendocardial fibrosis in 1 CSS and 1 RA patient, while subendocardial myocardial infarction in 3 SLE, 1 MCTD, 1 PMR and 2 RA patients. CMR re-evaluation after 6 and 12months of rheumatic and cardiac treatment, available in 28/52 CTDs with increased T2 ratio, showed significant improvement in T2 ratio (p<0.001), non-significant change in LGE extent and normalisation of those with impaired LV function.
  
  
  CONCLUSIONS
  Occult CMR lesions, including oedema, myocarditis, diffuse subendocardial fibrosis and myocardial infarction are not unusual in treatment naïve CTDs and may be reversed with appropriate treatment.
authors.affiliation: Onassis Cardiac Surgery Center, Athens, Greece. Electronic address: soma13@otenet.gr.
authors.forename: Sophie
authors.initials: S
authors.lastname: Mavrogeni
authors.affiliation: Onassis Cardiac Surgery Center, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Markousis-Mavrogenis
authors.affiliation: Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece.
authors.forename: Loukia
authors.initials: L
authors.lastname: Koutsogeorgopoulou
authors.affiliation: Department of Rheumatology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Theodoros
authors.initials: T
authors.lastname: Dimitroulas
authors.affiliation: Onassis Cardiac Surgery Center, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Bratis
authors.affiliation: Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK.
authors.forename: George D
authors.initials: GD
authors.lastname: Kitas
authors.affiliation: Joint Academic Rheumatology Program, National and Kapodistrian University of Athens Medical School, Greece.
authors.forename: Petros
authors.initials: P
authors.lastname: Sfikakis
authors.affiliation: Joint Academic Rheumatology Program, National and Kapodistrian University of Athens Medical School, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Tektonidou
authors.affiliation: Athens Navy Hospital, Athens, Greece.
authors.forename: Georgia
authors.initials: G
authors.lastname: Karabela
authors.affiliation: Athens Navy Hospital, Athens, Greece.
authors.forename: Efthymios
authors.initials: E
authors.lastname: Stavropoulos
authors.affiliation: Athens Navy Hospital, Athens, Greece.
authors.forename: Gikas
authors.initials: G
authors.lastname: Katsifis
authors.affiliation: Sismanoglion hospital, Athens, Greece.
authors.forename: Kyriaki A
authors.initials: KA
authors.lastname: Boki
authors.affiliation: Sismanoglion hospital, Athens, Greece.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Kitsiou
authors.affiliation: Sismanoglion hospital, Athens, Greece.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Filaditaki
authors.affiliation: Joint Academic Rheumatology Program, National and Kapodistrian University of Athens Medical School, Greece.
authors.forename: Elias
authors.initials: E
authors.lastname: Gialafos
authors.affiliation: Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece.
authors.forename: Sotiris
authors.initials: S
authors.lastname: Plastiras
authors.affiliation: Onassis Cardiac Surgery Center, Athens, Greece.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Vartela
authors.affiliation: Onassis Cardiac Surgery Center, Athens, Greece.
authors.forename: Genovefa
authors.initials: G
authors.lastname: Kolovou
mesh_terms: D000328:Adult; D003240:Connective Tissue Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D004452:Echocardiography / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
keywords: Cardiovascular magnetic resonance; Coronary artery; Myocardial fibrosis; Myocardial inflammation; Myocardial ischemia; Systemic vasculitis