Rheumatology Medical News about necrotizing vasculitides, cardiovascular, MRI

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Detection of coronary artery lesions and myocardial necrosis by magnetic resonance in systemic necrotizing vasculitides
Arthritis Care and Research , 08/11/09

Mavrogeni S et al. – Cardiovascular MRI assessment of pts with systemic vasculitis shows coronary ectatic disease for most pts with microscopic polyangiitis (MPA) and polyarteritis nodosa (PAN) and for several pts with Wegener's granulomatosis (WG). Myocardial necrosis can be detected in MPA and Churg-Strauss syndrome (CSS).

Methods

Study of myocardium and coronary artery involvement in pts with systemic necrotizing vasculitides by cardiovascular MRI
Magnetic resonance angiography and contrast-enhanced MRI to assess:
- Coronary arteries:
  - Left anterior descending (LAD)
  - Left circumflex (LCx)
  - Right coronary artery (RCA)
- Myocardium
Subjects: 39 vasculitis pts asymptomatic for cardiac disease:
- 16 with microscopic polyangiitis (MPA)
- 11 with Wegener's granulomatosis (WG)
- 9 with Churg-Strauss syndrome (CSS)
- 3 with polyarteritis nodosa (PAN)
Comparison with age-matched disease-control pts with RA, SLE, and with healthy controls with normal coronaries

Results

Pts with MPA, WG, and PAN (but not with CSS) showed increased maximal diameters of coronary arteries vs healthy controls and with both disease-control groups
Fusiform coronary aneurysms detected in pts with MPA (4/16) and PAN (2/3)
Coronary ectasias evident in pts with MPA (14/16) and WG (2/11)
Presence of myocardial necrosis only in pts with MPA (2/16) and CSS (3/8)

Exclusive Author Commentary
Sophie Mavrogeni, 08/12/09

The application of cardiovascular magnetic resonance imaging (CMR) in the evaluation of the heart either in coronary artery disease/ cardiomyopathies or in systemic diseases with cardiovascular involvement offers many advantages. CMR is a noninvasive, non radiating technique with excellent reproducibility, able to perform evaluation of heart function and tissue characterization in different pathological processes. This is of special value in rheumatic diseases, where no other imaging technique can offer evaluation of inflammation in different organs. Additionally, it is the current gold standard for the detection of myocardial necrosis, which can be missed by other imaging techniques, like heart echocardiography and scintigraphy. Furthermore, it is an excellent technique for the detection of coronary artery ectasia/aneurysm, found in different type of vasculitis. CMR can offer the “one stop shop”, that means the evaluation of inflammation, function, necrosis of the myocardium and coronary artery anatomy in one examination. In rheumatic diseases, where the heart involvement seems to be rather multi-factorial and appears as a result of coronary artery disease, myocardial inflammation and/ or myocardial necrosis, the application of CMR can give valuable information, before the heart damage will be clinically overt. The benefit and the possible treatment modification, as a result of the application of CMR, remain to be proved in further studies.

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