Detection of coronary artery lesions and myocardial necrosis by magnetic resonance in systemic necrotizing vasculitides

• Published in: Arthritis and rheumatism 2009-08, Vol.61 (8), p.1121-1129
• Main Authors: Mavrogeni, S., Manoussakis, M. N., Karagiorga, T. C., Douskou, M., Panagiotakos, D., Bournia, V., Cokkinos, D. V., Moutsopoulos, H. M.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - pathology; Biological and medical sciences; Churg-Strauss Syndrome - complications; Churg-Strauss Syndrome - pathology; Contrast Media - administration & dosage; Coronary Aneurysm - etiology; Coronary Aneurysm - pathology; Coronary Artery Disease - etiology; Coronary Artery Disease - pathology; Coronary Vessels - pathology; Dilatation, Pathologic - etiology; Dilatation, Pathologic - pathology; Diseases of the osteoarticular system; Female; Gadolinium DTPA - administration & dosage; Granulomatosis with Polyangiitis - complications; Granulomatosis with Polyangiitis - pathology; Humans; Image Enhancement - methods; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - pathology; Magnetic Resonance Imaging - methods; Male; Medical sciences; Middle Aged; Myocardial Infarction - etiology; Myocardial Infarction - pathology; Polyarteritis Nodosa - complications; Polyarteritis Nodosa - pathology; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis
• ISSN: 0004-3591; 0893-7524; 1529-0131; 1529-0123
• DOI: 10.1002/art.24695

Objective Myocardium and coronary arteries can occasionally be affected in patients with systemic necrotizing vasculitides; however, such involvement has not been systematically assessed using cardiovascular magnetic resonance imaging (MRI). Methods Magnetic resonance angiography and contrast‐enhanced MRI were applied for the assessment of coronary arteries (the left anterior descending [LAD], left circumflex [LCx], and right coronary artery [RCA]) and myocardium, respectively, in 39 patients with vasculitis who were asymptomatic for cardiac disease (16 with microscopic polyangiitis [MPA], 11 with Wegener's granulomatosis [WG], 9 with Churg‐Strauss syndrome [CSS], and 3 with polyarteritis nodosa [PAN]). Data were compared with age‐matched disease‐control patients with rheumatoid arthritis (n = 20) or systemic lupus erythematosus (n = 13), and with healthy control individuals with normal coronaries (n = 40). Results Patients with MPA, WG, and PAN (but not with CSS) were found to display significantly increased maximal diameters of coronary arteries compared with healthy controls (for MPA and WG; P < 0.001 for LAD and RCA, and P < 0.01 for LCx) and with both disease‐control groups (for only MPA; P < 0.01 for LAD and RCA, and P < 0.05 for LCx). Fusiform coronary aneurysms were detected in patients with MPA (4/16) and PAN (2/3), whereas coronary ectasias were evident in patients with MPA (14/16) and WG (2/11). The presence of myocardial necrosis (by assessment of late gadolinium‐enhanced images) was identified only in patients with MPA (2/16) and CSS (3/8 studied). Conclusion Cardiovascular MRI assessment of patients with systemic vasculitis revealed coronary ectatic disease in the majority of patients with MPA and PAN, as well as in several patients with WG. Myocardial necrosis can be detected in MPA and CSS.