Use of advanced cardiovascular imaging in rheumatic immune-mediated inflammatory diseases

OBJECTIVES: To evaluate real-world use of advanced cardiovascular imaging in less common and rare rheumatic immune-mediated inflammatory diseases (IMIDs) and identify variation in practice to inform future studies and clinical guidelines. METHODS: A retrospective, multi-centre quality improvement project was conducted across four major hospitals in the UK. Adults with systemic lupus erythematosus, systemic sclerosis, inflammatory myopathy, vasculitis or primary Sjögren's disease who underwent cardiac magnetic resonance (CMR), CT coronary angiography (CTCA) or positron emission tomography (PET) between January 2023 and December 2024 were included. Demographics, underlying IMID, cardiovascular risk factors, imaging indications, findings and management were extracted using a standardised proforma and analysed. RESULTS: A total of 294 imaging studies were performed in 261 patients (72.4% female, 65.9% aged 40-74 years) comprising 137 (46.6%) CMR, 40 (13.6%) CTCA, and 117 (39.8%) PET scans. Indications varied by modality and centre. Cardiovascular abnormalities were reported in 175/294 (59.5%), most commonly in vasculitis (53.7%). Notably, 54/63 (85.7%) of abnormal PET and 61/89 (68.5%) of abnormal CMR scans were in asymptomatic patients. Imaging findings prompted cardiology referral/ongoing follow-up in 59.5% and changes to IMID treatment in 31.3%, but only 23.1% were discussed in a formal multidisciplinary team (MDT). CONCLUSIONS: Advanced cardiovascular imaging frequently identifies cardiovascular involvement in rheumatic IMIDs, including in asymptomatic patients. Treatment adjustments occurred in a third of patients, although largely undertaken outside established MDT processes. These findings emphasise the need for better understanding of imaging-based findings and for cardio-rheumatology MDTs to support integrated decision-making to improve patient outcomes.