Research Topic

Cardiovascular Involvement in Autoimmune Diseases

About this Research Topic

Patients with autoimmune diseases have a significantly higher risk of cardiovascular disease (CVD), including myo-pericarditis, 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 diseases including thyroid and rheumatic diseases may present CVD involvement at any stage of their 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 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 myo-pericarditis. In this case, normal values of these indices are not reliable indicators for early detection of myo-pericardial inflammation. Furthermore, cardiac indices such as troponin and atrial natriuretic peptide maybe also not increased in a 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 is widely available. However, it is operator and window dependent modality unable to perform tissue characterization. On the other hand, CMR although it is ideal to provide early detailed information regarding function and tissue characterization, it 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 which 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 in Frontiers in Cardiovascular Medicine, we 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.


Keywords: autoimmune disease, myocardial inflammation/arrhythmia, autoantibodies, cardiovascular imaging, ECG, 24H Holter recording, autoimmune medication


Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

Patients with autoimmune diseases have a significantly higher risk of cardiovascular disease (CVD), including myo-pericarditis, 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 diseases including thyroid and rheumatic diseases may present CVD involvement at any stage of their 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 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 myo-pericarditis. In this case, normal values of these indices are not reliable indicators for early detection of myo-pericardial inflammation. Furthermore, cardiac indices such as troponin and atrial natriuretic peptide maybe also not increased in a 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 is widely available. However, it is operator and window dependent modality unable to perform tissue characterization. On the other hand, CMR although it is ideal to provide early detailed information regarding function and tissue characterization, it 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 which 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 in Frontiers in Cardiovascular Medicine, we 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.


Keywords: autoimmune disease, myocardial inflammation/arrhythmia, autoantibodies, cardiovascular imaging, ECG, 24H Holter recording, autoimmune medication


Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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Submission Deadlines

30 September 2021 Abstract
31 December 2021 Manuscript

Participating Journals

Manuscripts can be submitted to this Research Topic via the following journals:

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Topic Editors

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Submission Deadlines

30 September 2021 Abstract
31 December 2021 Manuscript

Participating Journals

Manuscripts can be submitted to this Research Topic via the following journals:

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