Cardiovascular magnetic resonance in autoimmune rheumatic diseases: a clinical consensus document by the European Association of Cardiovascular Imaging.

Autoimmune rheumatic diseases (ARDs) involve multiple organs including the heart and vasculature. Despite novel treatments, patients with ARDs still experience a reduced life expectancy, partly caused by the higher prevalence of cardiovascular disease (CVD). This includes CV inflammation, rhythm disturbances, perfusion abnormalities (ischaemia/infarction), dysregulation of vasoreactivity, myocardial fibrosis, coagulation abnormalities, pulmonary hypertension, valvular disease, and side-effects of immunomodulatory therapy. Currently, the evaluation of CV involvement in patients with ARDs is based on the assessment of cardiac symptoms, coupled with electrocardiography, blood testing, and echocardiography. However, CVD may not become overt until late in the course of the disease, thus potentially limiting the therapeutic window for intervention. More recently, cardiovascular magnetic resonance (CMR) has allowed for the early identification of pathophysiologic structural/functional alterations that take place before the onset of clinically overt CVD. CMR allows for detailed evaluation of biventricular function together with tissue characterization of vessels/myocardium in the same examination, yielding a reliable assessment of disease activity that might not be mirrored by blood biomarkers and other imaging modalities. Therefore, CMR provides diagnostic information that enables timely clinical decision-making and facilitates the tailoring of treatment to individual patients. Here we review the role of CMR in the early and accurate diagnosis of CVD in patients with ARDs compared with other non-invasive imaging modalities. Furthermore, we present a consensus-based decision algorithm for when a CMR study could be considered in patients with ARDs, together with a standardized study protocol. Lastly, we discuss the clinical implications of findings from a CMR examination.
Competing Interests: Conflict of interest: E.D. has received speaker fees or honoraria from Astra Zeneca, Pfizer, Bristol Myers Squibb, General Electric, and Abbott Vascular, and research funding from GE Healthcare. L.G. has received speaker fees or honoraria from GE Healthcare, Caption Health, Philips Healthcare, and EchoNous. J.A.C. Lima has received honoraria from Astra Zeneca. N.A.-M. has received speaker fees or honoraria from GE Healthcare and Abbott Vascular. M.M.-C. has received research funding from MSD. M.M. has received research funding from the National Scleroderma Foundation. R.N. has received speaker fees from Sanofi Genzyme, Bayer, and Boehringer-Ingelheim, and unrestricted research funding from Philips Volcano and Biotronik. N.A.B.N. has received speaker fees or honoraria from Novo Nordisk and Servier, research funding from GlaxoSmithKline, and royalties for intellectual property from UpToDate. S.E.P. provides consultancy to and is stockowner of Circle Cardiovascular Imaging. L.E.S. has received speaker fees or honoraria from Pfizer and Janssen. J.S. has received unrestricted research grant from Bayer. P.S. has received speaker fees or honoraria from Astra Zeneca, Boehringer-Ingelheim, Medtronic, Novartis, Servier, and Respicardia. L.M.S.-G. has received speaker fees or honoraria from Amgen. J.W. has received speaker fees or honoraria from Abbott Vascular and research funding form GE Healthcare.
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