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The heart in systemic lupus erythematosus - A comprehensive approach by cardiovascular magnetic resonance tomography
Thilo Burkard1,2,3, Marten Trendelenburg3,4, Thomas Daikeler3,5
1Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Insights
Cardiac involvement is common in systemic lupus erythematosus (SLE) patients, even without symptoms. Cardiovascular magnetic resonance (CMR) can detect this subclinical heart disease early, aiding timely treatment and identifying risk factors.
Area of Science:
- Cardiology
- Rheumatology
- Medical Imaging
Background:
- Systemic lupus erythematosus (SLE) is associated with significant cardiac morbidity and mortality, primarily due to coronary artery disease (CAD) and myocarditis.
- The prevalence of subclinical heart disease in SLE patients remains largely unknown.
- Early detection of cardiac involvement in SLE is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the utility of a comprehensive cardiovascular magnetic resonance (CMR) protocol for the early diagnosis of heart disease in SLE patients without known CAD.
- To assess the prevalence of subclinical cardiac abnormalities in SLE patients using CMR.
Main Methods:
- A prospective, observational, cross-sectional study involving 30 consecutive SLE patients meeting at least 4 ACR criteria for SLE classification and without known CAD.
- Utilized a comprehensive CMR protocol including cine, late gadolinium enhancement (LGE), and stress perfusion sequences.
- ECG and blood sampling were also performed for each participant.
Main Results:
- CMR revealed abnormalities in 13 out of 30 (43%) SLE patients.
- Specific findings included late gadolinium enhancement (LGE) in 9 patients, stress perfusion deficits in 5, and pericardial effusion (PE) in 7.
- Patients with non-ischemic LGE showed a higher incidence of microalbuminuria, while those with perfusion deficits had a history of hypertension, renal disorders, ECG repolarization abnormalities, and larger LV end-diastolic volume index.
- No correlation was found between clinical symptoms and CMR results.
Conclusions:
- Cardiac involvement detected by CMR is frequent in SLE patients and often presents without typical symptoms.
- CMR is a valuable tool for identifying subclinical cardiac involvement in SLE, potentially enabling earlier therapeutic interventions.
- The study identified potential risk factors associated with cardiac involvement in SLE patients.
Background:
In 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.
Methods:
In 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.
Results:
30 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.
Conclusion:
Our 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.
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