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The role of first-pass perfusion deficit in the detection of cardiac subendocardial manifestation in patients with autoimmune vasculitis

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Abstract

This report describes the potential of cardiac magnetic resonance imaging (cMRI) based on myocardial first-pass perfusion imaging in the visualization of cardiac manifestations in autoimmune vasculitis, which in the heart are typically localized at the level of small subendocardial vessels. Two patients with primary or secondary autoimmune vasculitis were investigated in this study. Myocardial first-pass perfusion imaging was performed using an ECG-gated T1-weighted MRI sequence after the injection of intravenous bolus of gadolinium chelate. In both cases, the cMRI showed findings of subendocardial first-pass perfusion deficit (FPPD), a phenomenon so far described as microvascular obstruction (MVO) only in patients with acute cardiac infarction due to thromboembolic obstruction of small myocardial vessels. The two patients showed local subendocardial and myocardial hypoenhancement (characterized by a darker appearance than normal myocardial tissue), which is the typical morphological stigma of FPPD initially after injection of contrast media. The perfusion deficit, although morphologically very similar to the well-known phenomenon of MVO in acute cardiac infarction, was conceivably caused by different vasculitis-specific mechanisms such as occlusion of the microvasculature with erythrocytes, neutrophils and cellular debris. This study indicates that FPPD is useful for the non-invasive assessment of the microvasculature in patients with acute cardiac involvement in primary and secondary vasculitis.

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Abbreviations

cMRI:

Cardiac magnetic resonance imaging

CRP:

C-reactive protein

FPP:

First-pass perfusion

FPPD:

First-pass perfusion deficit

MVO:

Microvascular obstruction

SLE:

Systemic lupus erythematosus

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Authors and Affiliations

  1. Department of Internal Medicine III, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany

    Alexander Pfeil, Gabriele Lehmann & Gunter Wolf

  2. Institute of Diagnostic and Interventional Radiology, SRH Wald-Klinikum Gera, Straße des Friedens 122, 07548, Gera, Germany

    Joachim Böttcher

  3. Institute of Diagnostic and Interventional Radiology, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany

    Andreas Hansch

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  1. Alexander Pfeil
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  2. Gabriele Lehmann
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  3. Joachim Böttcher
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  4. Gunter Wolf
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  5. Andreas Hansch
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Correspondence to Alexander Pfeil.

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Pfeil, A., Lehmann, G., Böttcher, J. et al. The role of first-pass perfusion deficit in the detection of cardiac subendocardial manifestation in patients with autoimmune vasculitis. Rheumatol Int 33, 29–35 (2013). https://doi.org/10.1007/s00296-011-2310-3

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  • DOI: https://doi.org/10.1007/s00296-011-2310-3

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