Second Cardiology Department, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Greece.
Second Cardiology Department, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Greece.
JACC Cardiovasc Imaging. 2019 Dec;12(12):2517-2537. doi: 10.1016/j.jcmg.2018.06.033. Epub 2019 Mar 13.
Rheumatic diseases are immune-mediated inflammatory multisystem diseases with frequent cardiovascular manifestations including perimyocarditis, valvular disease, coronary artery disease, heart failure with or without preserved ejection fraction, pulmonary hypertension, aneurysms, and thrombosis. Echocardiography, carotid ultrasonography, cardiac computed tomography, cardiac magnetic resonance imaging, and positron emission tomography are valid diagnostic tools for the detection of the cardiovascular complications of the multisystem diseases that frequently determine prognosis. Furthermore, the findings of these methods may offer additive risk stratification in asymptomatic patients over the conventional risk scores used to assess cardiovascular risk in the primary prevention setting. Finally, the imaging methods offer a unique opportunity to monitor the effects of treatment on atherosclerotic lesions, coronary microcirculatory dysfunction, myocardial inflammation and fibrosis. However, studies are needed to investigate whether improvement of imaging markers by treatment or selection of treatment according to its effects on surrogate imaging markers is linked to improved prognosis.
风湿性疾病是免疫介导的炎症性多系统疾病，常伴有心血管表现，包括心肌炎、瓣膜病、冠状动脉疾病、射血分数保留或不保留的心衰、肺动脉高压、动脉瘤和血栓形成。超声心动图、颈动脉超声、心脏计算机断层扫描、心脏磁共振成像和正电子发射断层扫描是检测多系统疾病心血管并发症的有效诊断工具，这些并发症常决定预后。此外，这些方法的发现可为无症状患者提供附加的危险分层，优于用于评估初级预防中心血管风险的传统危险评分。最后，这些影像学方法为监测治疗对动脉粥样硬化病变、冠状动脉微循环功能障碍、心肌炎症和纤维化的影响提供了独特的机会。然而，仍需要研究来探讨治疗是否可以改善影像学标志物，或者根据其对替代影像学标志物的作用来选择治疗是否与改善预后有关。
