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Updated: Jan 11, 2026
Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
Cardiovascular magnetic resonance as an initial screening tool in individuals with SLE and chest pain
Isak Samuelsson1,2, Simon Thalén3,4, Giorgia Grosso5
1Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden isak.samuelsson@ki.se.
Insights
Cardiovascular magnetic resonance (CMR) helps identify cardiac ischemia, coronary artery disease (CAD), and coronary microvascular dysfunction (CMD) in Systemic Lupus Erythematosus (SLE) patients with chest symptoms. This imaging technique altered management in one-third of cases.
Area of Science:
- Cardiology
- Rheumatology
- Medical Imaging
Background:
- Systemic Lupus Erythematosus (SLE) patients frequently experience chest pain.
- Differentiating cardiac causes like coronary artery disease (CAD), coronary microvascular dysfunction (CMD), pericarditis, and myocarditis is crucial.
Purpose of the Study:
- To utilize cardiovascular magnetic resonance (CMR) to diagnose cardiac conditions in SLE patients presenting with chest symptoms.
- To assess the clinical utility of CMR in guiding treatment decisions.
Main Methods:
- Adult SLE patients with cardiac-suggestive chest symptoms underwent CMR between 2018-2023.
- Quantitative myocardial perfusion mapping was performed, with adenosine stress imaging when appropriate.
- Medical records were reviewed to determine if CMR findings altered patient management or led to interventions.
Main Results:
- CMR diagnosed CAD in 21% and CMD in 14% of symptomatic SLE patients; pericarditis was found in 16%.
- Myocarditis was not diagnosed in any participant.
- CMR identified no cause for symptoms in 63% of patients, but altered medical management in 32%.
Conclusions:
- Cardiac ischemia, including CAD and CMD, is a significant cause of chest symptoms in SLE, more prevalent than pericarditis or myocarditis.
- CMR demonstrates potential for early detection and improved management of cardiac conditions in symptomatic SLE patients.
- Further research with larger cohorts is needed to validate findings and assess the long-term prognostic value of early CMR.
Objective:
Individuals with SLE commonly report chest pain or discomfort. We performed cardiovascular magnetic resonance (CMR) to differentiate coronary artery disease (CAD), coronary microvascular dysfunction (CMD), pericarditis and myocarditis in individuals with SLE who presented with chest symptoms. We also assessed the clinical utility of CMR.
Methods:
Adults with SLE were included if reporting chest pain or dyspnoea suggestive of cardiac involvement to a rheumatologist between 2018 and 2023. Individuals underwent CMR, including quantitative myocardial perfusion mapping at rest and during adenosine stress if not contraindicated. CAD, CMD, pericarditis and myocarditis were identified by CMR. Confirmatory investigations were performed when indicated. We reviewed medical files to assess if CMR led to altered medical treatment or invasive interventions.
Results:
Nineteen individuals with SLE (84% female) with a median age of 39 (IQR 31-55) years underwent CMR, of whom 14 (74%) were examined using adenosine stress. Symptoms prompting inclusion were pleuritic chest pain in 10/19 (53%), chest pain triggered by exercise or relieved by nitrates or rest in 2/19 (11%), other types of chest pain in 5/19 (26%) and dyspnoea suggestive of cardiac involvement in 2/19 (11%). CAD, CMD and pericarditis were diagnosed in 3/14 (21%), 2/14 (14%) and 3/19 (16%) individuals, respectively. None had myocarditis. CMR revealed no cause of chest symptoms in 12/19 (63%). The CMR results led to altered medical management in 6/19 (32%) individuals.
Conclusions:
This cross-sectional study highlights cardiac ischaemia as a cause of chest symptoms in SLE. Notably, CAD and CMD were together more common than pericarditis and myocarditis. CMR may aid early detection and treatment of these conditions, as it altered medical management in one-third of cases. Larger studies are needed to confirm our findings and prospectively evaluate the long-term prognostic impact of early CMR in symptomatic individuals with SLE.
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