Mavrogeni Sophie, Markousis-Mavrogenis George, Koutsogeorgopoulou Loukia, Dimitroulas Theodoros, Bratis Konstantinos, Kitas George D, Sfikakis Petros, Tektonidou Maria, Karabela Georgia, Stavropoulos Efthymios, Katsifis Gikas, Boki Kyriaki A, Kitsiou Anastasia, Filaditaki Vasiliki, Gialafos Elias, Plastiras Sotiris, Vartela Vasiliki, Kolovou Genovefa
Onassis Cardiac Surgery Center, Athens, Greece.
Onassis Cardiac Surgery Center, Athens, Greece.
Int J Cardiol. 2017 Jun 1;236:151-156. doi: 10.1016/j.ijcard.2017.01.104. Epub 2017 Feb 1.
BACKGROUND-AIM: 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.
PATIENTS-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.
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.
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.
背景-目的：超声心动图已描述了结缔组织病（CTD）诊断时的心脏受累情况。我们推测心血管磁共振（CMR）能在CTD诊断时检测出隐匿性病变。
患者-方法：对78例初治且无心脏受累的CTD患者（年龄43±11岁，59例女性/19例男性）在诊断后早期进行CMR检查[5例大动脉炎（TA）、4例变应性肉芽肿性血管炎（CSS）、5例韦格纳肉芽肿（WG）、16例系统性红斑狼疮（SLE）、12例类风湿关节炎（RA）、8例混合性结缔组织病（MCTD）、12例强直性脊柱炎（AS）、3例巨细胞动脉炎（PMR）、8例系统性硬化症（SSc）和5例皮肌炎（DM）]。分别通过T2>2且延迟强化（LGE）阳性评估急性病变，T2<2且LGE阳性评估慢性病变。
在3/5的TA、3/4的CSS、4/5的WG、10/16的SLE、9/12的RA、6/8的MCTD、4/12的AS、1/3的PMR、2/8的SSc和2/5的DM中，T2比值高于正常水平（2.78±0.25对1.5±0.2，p<0.01）。在1例TA、1例SLE、1例RA、1例SSc和2例DM患者中发现心肌炎；在1例CSS和1例RA患者中发现弥漫性心内膜下纤维化，而在3例SLE、1例MCTD、例PMR和2例RA患者中发现心内膜下心肌梗死。在52例T2比值升高的CTD患者中，28例在风湿和心脏治疗6个月及12个月后进行CMR复查，结果显示T2比值有显著改善（p<0.001），LGE范围无显著变化，左心室功能受损者恢复正常。
隐匿性CMR病变，包括水肿、心肌炎、弥漫性心内膜下纤维化和心肌梗死，在初治CTD患者中并不少见，适当治疗后可能会逆转。
