Introduction: Rheumatoid arthritis (RA) affects many organs, including the heart. Cardiac magnetic resonance
(CMR) can assess heart pathophysiology in RA.
Aim: To evaluate, using CMR, RA patients under remission with recent onset of cardiac symptoms.
Patients and Methods: Twenty RA under remission (15F/5M), aged 60±5 yrs, with recent onset of cardiac symptoms
(RAH), were prospectively evaluated by CMR. The CMR included left ventricular ejection fraction (LVEF), T2-weighted
(T2-W), early (EGE) and late gadolinium enhanced (LGE) images evaluation. Their results were compared with those of
20 RA under remission without cardiac symptoms (RAC) and 18 with systemic lupus erythematosus (SLE) with clinically
Results: Cardiac enzymes were abnormal in 5/20 RAH. CMR revealed inferior wall myocardial infarction in 2/20 (1M,
1F) and myocarditis in 13/20 (8M/5F) RAH. The T2 ratio of myocardium to skeletal muscle was increased in RAH and
SLE compared to RAC (2.5 ± 0.05 and 3.4±0.7 vs 1.8 ± 0.5, p<0.001). EGE was increased in RAH and SLE compared to
RAC (15 ± 3 and 12±4.7 vs 2.7±0.8, p<0.001). Epicardial LGEs were identified in 10/13 and pericarditis in 6/13 RAH.
Coronary angiography, performed in 5 RAH with increased cardiac enzymes, proved a right coronary artery obstruction in
2/5. In 3/5 with CMR positive for myocarditis, coronary arteries were normal, but endomyocardial biopsy revealed
inflammation with normal PCR. An RA relapse was observed after 7-40 days in 10/13 RAH with myopericarditis. The
one year follow up showed that a) RAH with myocarditis had more disease relapses and b) CHF was developed in 4 RAH
Conclusions: Myopericarditis with atypical presentation, diagnosed by CMR in RA under remission, may precede the
development of RA relapse. In 1 year follow up, RA patients with history of myocarditis have a higher frequency of
disease relapse and may develop CHF.