Cardio-Rheumatology: From Inflammation to Heart Failure. The Emerging Role of Cardiovascular Magnetic Resonance Imaging

Systemic inflammation is a major trigger for cardiovascular disease (CVD) and consequent heart failure (HF). Our purpose is to present the impact of inflammation in the development of HF in autoimmune rheumatic diseases (ARDs) and the emerging role of Cardiovascular Magnetic Resonance (CMR). ARDs represent the best example of systemic inflammation and are associated with increased risk of cardiovascular disease (CVD) finally leading to heart failure with preserved (HFpEF) or reduced ejection fraction (HFrEF). Systemic and local inflammation of the CV system may lead to myo-pericarditis, autoimmune inflammatory cardiomyopathy (AIC), valvular heart disease (VHD) and macro-/micro-coronary artery disease (CAD). Furthermore, the anti-rheumatic medication, used to control systemic inflammation, may also lead to myocardial cytotoxic effect. Silent clinical presentation is the main characteristic of CVD in ARDs, which makes the early, accurate diagnosis challenging. Furthermore, although there is great progress in the development of new anti-rheumatic medication, the CVD incidence/mortality in ARDs is still higher, compared to the rest of the population. High clinical awareness and use of new advanced technologies, such as CMR that can perform function and tissue characterization in the same examination, was proven useful for early diagnosis, risk stratification and treatment evaluation of CVD in ARDs. Lastly, the cardio-protective effect of anti-rheumatic and the immunomo-dulatory effect of cardiac medication hold the promise for better CVD control and potentially mortality reduction.