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Reduced Left Ventricular Function on Cardiac MRI in SLE Patients Correlates with Measures of SLE Disease Activity and
Audrey M Hagiwara1, Erica Montano1, Gantseg Tumurkhuu1
1Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.
Insights
Forty percent of women with Systemic Lupus Erythematosus (SLE) exhibit coronary microvascular dysfunction (CMD). Cardiac MRI revealed impaired cardiac function and diffuse fibrosis linked to disease activity in SLE patients.
Area of Science:
- Cardiology
- Rheumatology
- Medical Imaging
Background:
- Women with Systemic Lupus Erythematosus (SLE) face increased cardiovascular disease (CVD) risks.
- Chest pain is common in SLE patients, often without obstructive coronary artery disease (CAD).
- Echocardiography shows reduced left ventricular (LV) function correlating with SLE activity.
Purpose of the Study:
- To investigate the relationship between SLE, inflammatory biomarkers, and cardiac function in female SLE patients using cardiac MRI (cMRI).
- To assess cardiac structure, function, and tissue characteristics in SLE patients with and without chest pain.
Main Methods:
- Stress-rest cMRI was used to evaluate LV structure, function, tissue characteristics, and myocardial perfusion reserve index (MPRI).
- Coronary microvascular dysfunction (CMD) was defined as MPRI <1.84.
- Serum inflammatory markers were analyzed, and relationships between clinical and cMRI data were assessed.
Main Results:
- 40% of SLE subjects demonstrated CMD (MPRI < 1.84).
- SLE subjects had higher LV volumes/mass and lower LV systolic function compared to controls.
- SLE Damage Index (SLICC DI) correlated with worse cardiac function and higher T1 values; CRP correlated with higher cardiac output.
Conclusions:
- 40% of the female SLE cohort presented with CMD.
- SLICC DI correlated with impaired cardiac function and diffuse fibrosis, suggesting a link between disease activity and cardiac remodeling.
- Non-invasive cMRI shows promise for monitoring cardiovascular health in SLE patients.
Background:
Women with SLE have an elevated risk of CVD morbidity and mortality and frequently report chest pain in the absence of obstructive CAD. Echocardiographic studies often demonstrate reduced LV function, correlating with higher disease activity. We used cardiac MRI (cMRI) to investigate the relationship between SLE, related inflammatory biomarkers and cardiac function in female SLE patients.
Methods:
Women with SLE reporting chest pain with no obstructive CAD (n=13) and reference controls (n=22) were evaluated using stress-rest cMRI to measure LV structure, function, tissue characteristics, and myocardial perfusion reserve index (MPRI). Coronary microvascular dysfunction (CMD) was defined as MPRI <1.84. Serum samples were analyzed for inflammatory markers. Relationships between clinical and cMRI values of SLE subjects were assessed, and groups were compared.
Results:
40% of SLE subjects had MPRI < 1.84 on cMRI. Compared to controls, SLE subjects had higher LV volumes and mass and lower LV systolic function. SLICC DI was related to worse cardiac function and higher T1. CRP was related to higher cardiac output and a trend to better systolic function, while ESR and fasting insulin were related to lower LV mass. Lower fasting insulin levels correlated with increased ECV.
Conclusions:
Among our female SLE cohort, 40% had CMD, and SLICC DI correlated with worse cardiac function and diffuse fibrosis. Higher inflammatory markers and low insulin levels may associate with LV dysfunction. Our findings underline the potential of non-invasive cMRI as a tool for monitoring cardiovascular function in SLE patients.
