Abstract
BackgroundIn systemic lupus erythematosus (SLE), cardiac manifestations, e.g. coronary artery disease (CAD) and myocarditis are leading causes of morbidity and mortality. The prevalence of subclinical heart disease in SLE is unknown. We studied whether a comprehensive cardiovascular magnetic resonance (CMR) protocol may be useful for early diagnosis of heart disease in SLE patients without known CAD.MethodsIn this prospective, observational, cross-sectional study CMR including cine, late gadolinium enhancement (LGE) and stress perfusion sequences, ECG, and blood sampling were performed in 30 consecutive SLE patients without known CAD. All patients fulfilled at least 4/11 American College of Rheumatology (ACR) Criteria for the classification of SLE.Results30 patients (83% female) were enrolled, mean age was 45±14 years and mean SLE disease duration was 10±8 years. 80% had low to moderate disease activity. All had a low SLE damage index. CMR was abnormal in 13/30 (43%), showing LGE in 9/13, stress perfusion deficits in 5/13 and pericardial effusion (PE) in 7/13. Patients with non-ischemic LGE had more often microalbuminuria while patients with stress perfusion deficits a history of hypertension, renal disorder as ACR criterion, repolarisation abnormalities on ECG and larger LV enddiastolic volume index. There was no correlation between clinical symptoms and CMR results.ConclusionOur study shows that cardiac involvement as observed by CMR is frequent in SLE and not necessarily associated with typical symptoms. CMR may thus help to detect subclinical cardiac involvement, which could lead to earlier treatment. Additionally we identify possible risk factors associated with cardiac involvement.
Highlights
Systemic lupus erythematosus (SLE) is a systemic, autoimmune disease which can affect virtually all organs[1]
We studied whether a comprehensive cardiovascular magnetic resonance (CMR) protocol may be useful for early diagnosis of heart disease in SLE patients without known coronary artery disease (CAD)
Patients with non-ischemic late gadolinium enhancement (LGE) had more often microalbuminuria while patients with stress perfusion deficits a history of hypertension, renal disorder as American College of Rheumatology (ACR) criterion, repolarisation abnormalities on ECG and larger left ventricular (LV) enddiastolic volume index
Summary
Systemic lupus erythematosus (SLE) is a systemic, autoimmune disease which can affect virtually all organs[1]. Pericarditis is part of the diagnostic criteria of the American College of Rheumatology (ACR), accelerated atherosclerosis leading to premature coronary artery disease (CAD), myocardial involvement and valvular heart disease with abacterial endocarditis have been described[3,4,5]. In autopsy studies evidence of myocardial involvement is found in up to 40% but is clinically diagnosed in only 10% of patients [8,9,10]. This diagnostic gap may not be closed by echocardiography since only 20% of asymptomatic patients showed left ventricular (LV) abnormalities, such as like LV dilatation, LV hypertrophy or LV dysfunction[11]. In systemic lupus erythematosus (SLE), cardiac manifestations, e.g. coronary artery disease (CAD) and myocarditis are leading causes of morbidity and mortality. We studied whether a comprehensive cardiovascular magnetic resonance (CMR) protocol may be useful for early diagnosis of heart disease in SLE patients without known CAD
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