SAT-392 CLINICAL ANALYSIS OF LUPUS NEPHRITIS AND LUPUS MYOCARDITIS AND APPLICATION OF CARDIAC MAGNETIC RESONANCE IN DIAGNOSIS

Abstract

To investigate the clinical manifestations, treatment and prognosis of patients with lupus nephritis (LN) and lupus myocarditis (LM), and the application of cardiac magnetic resonance (CMR) imaging, especially T1-mapping technique in LM diagnosis. Sixty-six patients (61 women and 5 men, with a median onset age of 29 (21,39) years) diagnosed LN and LM from October 2016 to March 2019. The diagnosis for LM was based on clinical manifestations, EKG, serum troponin (CnT) and ultrasonic cardiogram (UCG), or CMR, meeting the Lake-Louise criteria made by the American College of Cardiology in 2009; or T1-mapping > 1370ms. The myocarditis or myocardial injury caused by virus or myocardial ischemia was excluded. The conditions of getting rid of dialysis and recovery of cardiac function were followed up. Fifty-five patients (83.3%) had AKI, Thirty-eight patients (57.6%) met the diagnosis of thrombotic microangiopathy (TMA). Forty-six patients undergoing renal biopsy mainly had pathology of type IV and type IV + V. LM was the first symptom in 22 cases (33%), and 51 (77.3%) presented myocarditis symptoms, among whom 50 patients had dyspnea, 23 had orthopnoea, 18 had palpitation and 7 had chest pain. Serum NT-proBNP was increased in 59 (89.4%), and troponin was increased in 15 (22.7%). Abnormal electrocardiogram was found in 45. UCG showed left ventricular enlargement in 38 (57.6%), ventricular wall thickening in 18 (27.3%), abnormal left ventricular wall motion in 14 (21.2%), and left ventricular ejection fraction (LVEF) < 50% in 14 (21.2%). Sixty-three patients underwent CMR examination, 34 (54%) had LVEF < 50%, 27 (42.8%) had delayed myocardial enhancement, 4 (6.3%) had high signal of myocardial T2 weighted imaging, only 4 patient met the Lake-Louise criteria, and no patients had early enhancement. The T1-mapping values of 49 (77.8%) were increased (1436±74ms). Sixty (90.9%) patients received methylprednisolone venous shock, 42 (63.6%) needed CRRT therapy, and 24 (36.4%) received gamma globulin and dual plasmaphermoplasty. During the follow-up with median of 7.5 months, 21 patients got rid of dialysis, 3 patients became chronic cardiac dysfunction. When SLE involves the kidney and heart simultaneously, the damage of cardiac renal function is serious. Half of them are associated with thrombotic microvascular diseases, and early active treatment on the cardiac and renal function can achieve good improvement. New quantitative imaging technology T1-Mapping can improve the sensitivity of early diagnosis for LM.