ArticleJournal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance
Imaging therapeutic response to immunosuppression in IgG4-related coronary disease: The role of coronary wall enhancement cardiovascular magnetic resonance.
Article in Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCardiovascular magnetic resonance (CMR) imaging with contrast enhancement (CE) of the coronary artery wall has been proven effective for detecting coronary involvement in IgG4-related disease (IgG4-RD). This study seeks to further investigate the value of coronary wall CE on CMR in assessing treatment response.
methodsWe prospectively enrolled 30 IgG4-RD patients with coronary involvement and conducted follow-up evaluations. All participants underwent coronary wall imaging with CMR, both before and after treatment with a combination of glucocorticoids and steroid-sparing immunosuppression. Concurrently, inflammatory-related laboratory markers and IgG4-RD Responder Index (RI) scores were collected and analyzed.
resultsMost patients (87% [26/30]) exhibited a significant monthly reduction in total coronary wall CE area (ΔCE area/months = 0.32 [interquartile range (IQR): 0.03-0.88] cm²/month) and contrast-to-noise ratio (CNR) (ΔCNR/months = 0.09 [IQR: 0.01-0.41]/month). Both parameters were positively correlated with monthly changes in inflammatory markers, including ΔIgG4/months (r = 0.366 and 0.388, respectively), Δ erythrocyte sedimentation rate/months (r = 0.617 and 0.539), ΔIgG/months (r = 0.565 and 0.578), and ΔIgE/months (r = 0.512 and 0.499) (all P < 0.05). In the "heart/pericardium" organ-specific domain of the IgG4-RD RI, the rate of change in the modified index (RI') incorporating coronary wall CE was significantly greater than that of the standard RI (ΔRI'/months vs ΔRI/months: 0.1 vs 0, P = 0.006). Similarly, in the overall multi-organ assessment, ΔRI'/months showed a significant improvement over ΔRI/months (0.68 vs 0.67, P = 0.006). Moreover, ΔCE area/months correlated positively with both ΔRI/months (r = 0.627, P < 0.001) and ΔRI'/months (r = 0.683, P < 0.001). ΔCNR/months also correlated positively with ΔRI/months (r = 0.500, P = 0.005) and ΔRI'/months (r = 0.548, P = 0.002).
conclusionGlucocorticoid combined with steroid-sparing immunosuppression therapy is effective in treating IgG4-RD with coronary involvement. Coronary wall CE on CMR emerges as a valuable imaging biomarker that complements serological markers in assessing treatment response. Incorporating coronary wall CE enhances RI scoring, aiding therapeutic decisions and disease monitoring.
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