Diffuse, Subendocardial Vasculitis Identified by Cardiovascular Magnetic Resonance. Use of Images to Learn Pathophysiology

Diffuse Subendocardial Vasculitis (DSV), either primary or secondary, may occur during autoimmune diseases and lead to high mortality and morbidity. Recently, Cardiovascular Magnetic Resonance (CMR), a non-invasive, nonradiating technique, capable to perform tissue characterization has been used in the evaluation of cardiac vasculitis in the autoimmune diseases. CMR by performing tissue characterisation can detect diffuse, subendocardial oedema during the acute phase of DSV. To assess oedema, T2STIR images, T2 mapping and native T1 mapping can be used. Furthermore, diffuse subendocardial fibrosis can be also detected in both acute and chronic DSV. For this purpose, Late Enhanced Images (LGE) should be taken 15 minutes after the intravenous injection of the paramagnetic contrast agent gadolinium. Diffuse, subendocardial scar can be quantified and expressed as percentage of LV mass and this index have an important clinical value together with the LV ejection fraction in both ischemic and nonischemic cardiomyopathy. DSV can be identified by CMR in both acute and chronic autoimmune diseases. Acute DSV has the potential to be reversed completely by autoimmune and cardiac treatment modification. CMR is a powerful tool to early diagnose DSV and guide therapeutic decisions. However, further studies are needed to establish its impact in the patients’ risk stratification and treatment follow up.