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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Sep 26, 2015; 5(3): 136-143
Published online Sep 26, 2015. doi: 10.5662/wjm.v5.i3.136
“How many times must a man look up before he can really see the sky?” Rheumatic cardiovascular disease in the era of multimodality imaging
Sophie I Mavrogeni, George Markousis-Mavrogenis, David Hautemann, Kees van Wijk, Hans J Reiber, Genovefa Kolovou
Sophie I Mavrogeni, George Markousis-Mavrogenis, Genovefa Kolovou, Onassis Cardiac Surgery Center, 17674 Athens, Greece
David Hautemann, Kees van Wijk, Hans J Reiber, University of Leiden, 2333 ZA Leiden, The Netherlands
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest statement: There is no conflict of interest for any of the authors.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sophie I Mavrogeni, MD, FESC, Onassis Cardiac Surgery Center, 50 Esperou Street, 175-61 P. Faliro, 17674 Athens, Greece. soma13@otenet.gr
Telephone: +30-210-9882797 Fax: +30-210-9882797
Received: April 21, 2015
Peer-review started: April 24, 2015
First decision: June 9, 2015
Revised: July 28, 2015
Accepted: August 20, 2015
Article in press: August 21, 2015
Published online: September 26, 2015
Processing time: 147 Days and 22.9 Hours
Abstract

Cardiovascular involvement in rheumatic diseases (RD) is the result of various pathophysiologic mechanisms including inflammation, accelerated atherosclerosis, myocardial ischemia, due to micro- or macro-vascular lesions and fibrosis. Noninvasive cardiovascular imaging, including echocardiography, nuclear techniques, cardiovascular computed tomography and cardiovascular magnetic resonance, represents the main diagnostic tool for early, non-invasive diagnosis of heart disease in RD. However, in the era of multimodality imaging and financial crisis there is an imperative need for rational use of imaging techniques in order to obtain the maximum benefit at the lowest possible cost for the health insurance system. The oligo-asymptomatic cardiovascular presentation and the high cardiovascular mortality of RD necessitate a reliable and reproducible diagnostic approach to catch early cardiovascular involvement. Echocardiography remains the routine cornerstone of cardiovascular evaluation. However, a normal echocardiogram can not always exclude cardiac involvement and/or identify heart disease acuity and pathophysiology. Therefore, cardiovascular magnetic resonance is a necessary adjunct complementary to echocardiography, especially in new onset heart failure and when there are conflicting data from clinical, electrocardiographic and echocardiographic evaluation of RD patients.

Keywords: Echocardiography; Cardiovascular magnetic resonance; Nuclear imaging; Cardiovascular computed tomography; Myocardial perfusion-fibrosis; Coronary artery disease; Vasculitis; Rheumatic cardiovascular disease; Myocarditis

Core tip: The oligo-asymptomatic cardiovascular presentation and the high cardiovascular mortality of rheumatic diseases (RD) necessitate a reliable and reproducible diagnostic approach to catch early cardiovascular involvement. Echocardiography, although being the cornerstone of cardiac evaluation, can not always exclude cardiac involvement and/or identify acuity and pathophysiology of cardiac lesions. Therefore, cardiovascular magnetic resonance is a necessary adjunct, complementary to echocardiography, especially in new onset heart failure and when there are conflicting data from clinical, electrocardiographic and echocardiographic evaluation of RD patients.