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Distinctive clinical traits of lupus-related myocarditis: a multicentre retrospective study

Giuseppe A Ramirez1,2, Noora E A Holopainen1,2, Maria Gerosa3,4

  • 1Università Vita-Salute San Raffaele, Milan, Italy.

Rheumatology (Oxford, England)
|July 24, 2024
PubMed

Insights

Systemic lupus erythematosus (SLE)-related myocarditis (myoSLE) presents unique traits, often seen in women and linked to antiphospholipid syndrome. This condition indicates a more severe SLE course and specific antibody associations.

Area of Science:

  • Cardiology
  • Rheumatology
  • Immunology

Background:

  • Cardiovascular involvement is common in systemic lupus erythematosus (SLE).
  • Distinctive features of SLE-related myocarditis (myoSLE) compared to other myocarditis or SLE presentations are not well understood.
  • Understanding myoSLE is crucial for managing SLE patients with cardiac complications.

Purpose of the Study:

  • To identify unique clinical characteristics of myoSLE.
  • To compare myoSLE with myocarditis alone (onlyMyo) and SLE alone (onlySLE).
  • To explore associations between myoSLE and specific serological markers or disease severity.

Main Methods:

  • Retrospective analysis of 25 myoSLE patients against 279 onlySLE and 88 onlyMyo patients.
  • Stratification of SLE patients by disease duration (≤1 year vs >1 year, and 1-5, 5-10, >10 years).
  • Diagnosis of myocarditis via biopsy or MRI; SLE disease activity assessed using SLEDAI-2K.

Main Results:

  • myoSLE patients were more frequently women (72% vs 43%) and showed higher rates of conduction abnormalities (22% vs 5%) and left ventricular dysfunction compared to onlyMyo.
  • myoSLE was associated with higher inflammation markers, antiphospholipid syndrome, and elevated pro-brain natriuretic peptide levels.
  • Multivariate analysis linked myoSLE to anti-β-2-glycoprotein I antibodies (aB2GPI) and a greater number of affected British Isles Lupus Assessment Group (BILAG) domains.

Conclusions:

  • myoSLE exhibits distinct clinical features differentiating it from other forms of myocarditis.
  • The presence of aB2GPI and a history of more extensive SLE involvement are associated with myoSLE.
  • myoSLE may signify a more severe disease course in patients with systemic lupus erythematosus.
Abstract

Keywords:
antiphospholipid antibodiesdamagelong-term outcomesmyocarditissystemic lupus erythematosus

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