This Research Topic is the second volume of the “Cardiovascular Involvement in Autoimmune Diseases”. Please see the first volume here
Patients with autoimmune diseases have a significantly higher risk of cardiovascular disease (CVD), including myopericarditis, coronary artery disease (CAD), valvular heart disease, heart failure, and pulmonary arterial hypertension, which increase their risk of morbidity and mortality. Any type of autoimmune disease including thyroid and rheumatic diseases may present CVD involvement at any stage of its course. Specifically, in autoimmune rheumatic diseases, the life expectancy is 10 years shorter than in healthy individuals, with cardiovascular disease being the leading cause of death, and the mortality rate linked to clinical severity.
Early CVD diagnosis and treatment remains a significant challenge in autoimmune diseases. CVD in autoimmune diseases may present with atypical symptoms before, at diagnosis or even later during the course of the autoimmune disease. The CVD involvement in these diseases has some characteristics that should be taken under consideration, when we evaluate patients with autoimmune diseases. It is usually silent or oligo-symptomatic, its background includes different pathophysiologic mechanisms such as myocardial-pericardial-vascular inflammation, macro- micro-vascular coronary artery disease, valvular disease, and various patterns of fibrosis; furthermore, the acuity of cardiac involvement may be underestimated, due to nonspecific cardiac signs.
To detect the presence of CVD in autoimmune diseases blood inflammatory biomarkers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) and various imaging modalities have been already proposed. However, inflammatory biomarkers may be not increased in localized inflammatory processes, as in myopericarditis. In this case, normal values of these indices are not reliable indicators for early detection of myopericardial inflammation. Furthermore, cardiac indices such as troponin and atrial natriuretic peptide maybe also not increased in a slow progressing myocardial inflammation.
The role of various CV imaging modalities is of crucial importance, because they can detect early CVD and facilitate follow up. Their non-invasive nature and the capability to evaluate directly the heart make these modalities an indispensable tool for our fight against CVD in autoimmune diseases. Echocardiography and cardiovascular magnetic resonance (CMR) are the most commonly used imaging modalities in the evaluation of CVD in autoimmune diseases. Echocardiography has the advantage of being low-cost and widely available. However, it is an operator and window-dependent modality unable to perform tissue characterization. On the other hand, CMR although ideal to provide early detailed information regarding function and tissue characterization, is not widely available and still remains an expensive approach. Additionally, we should keep in mind that the majority of patients with autoimmune diseases are female and unable to exercise, due to arthritis or muscular weakness. Therefore, we should always use pharmacologic stress in these patients, if we want to have an accurate evaluation of myocardium under stress. Finally, we should use with caution imaging modalities that use radiation such as nuclear techniques and cardiac computed tomography, because these patients will need CV evaluation many times during their lives and therefore, the radiation load should be carefully considered.
In this Research Topic we hope to include research and review articles discussing the CVD involvement in autoimmune diseases, including diagnosis, follow-up, treatment, and impact of CVD in these patients. Our scope is to bring the reader in touch with this special group of diseases and finally create an algorithm regarding diagnosis and follow-up of CVD in autoimmune diseases.