Systemic lupus erythematosus cardiomyopathy—a case series demonstrating a reversible form of left ventricular...

Area of Science:

• Cardiology
• Rheumatology
• Internal Medicine

Background:

• Myocarditis is a known postmortem finding in systemic lupus erythematosus (SLE).
• However, endomyocardial biopsies in SLE cardiomyopathy (CM) cases rarely show evidence of myocarditis.
• The etiology of LV dysfunction in SLE remains unclear.

Purpose of the Study:

• To characterize the nature, course, and reversibility of left ventricular (LV) dysfunction in patients with SLE.
• To differentiate between myocarditis and other potential causes of cardiomyopathy in SLE patients.

Main Methods:

• Retrospective review of 526 SLE patient records.
• Inclusion criteria: ≥4 American College of Rheumatology criteria for SLE, ESR and hs-CRP testing, and echocardiogram showing LVEF <50%.
• Analysis of echocardiographic findings, clinical course, and outcomes.

Main Results:

• 14 SLE patients met the criteria; mean LVEF was 33.1 ± 9%.
• Generalized hypokinesis was the predominant echocardiographic pattern.
• 12 patients (86%) showed LVEF reversal within 1 week (mean improvement 21.0 ± 7%); 4 (29%) improved within 3 days.
• Coronary angiography and cardiac biopsy ruled out obstructive coronary disease and myocarditis, respectively, in a subset of patients.

Conclusions:

• The observed pattern of wall-motion abnormalities and rapid reversibility in SLE patients suggests stress cardiomyopathy.
• The findings challenge the traditional view of myocarditis as the primary cause of cardiomyopathy in SLE.
• Further research is needed to elucidate the precise mechanisms of cardiac dysfunction in SLE.