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The heart in systemic lupus erythematosus - A comprehensive approach by cardiovascular magnetic resonance tomography

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Burkard T1,2,3, Trendelenburg M3,4, Daikeler T3,5, Hess C2,3, Bremerich J3,6, Haaf P1,3, Buser P1,3, Zellweger MJ1,3. PLoS One. 2018 Oct 1;13(10):e0202105. doi: 10.1371/journal.pone.0202105. eCollection 2018.

Abstract

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1 Department of Cardiology, University Hospital Basel, Basel, Switzerland.

2 Medical Outpatient Department, University Hospital Basel, Basel, Switzerland.

3 University of Basel, Basel, Switzerland.

4 Division of Internal Medicine, University Hospital Basel, Basel, Switzerland.

5 Department of Rheumatology, University Hospital Basel, Basel, Switzerland.

6 Department of Radiology, University Hospital Basel, Basel, Switzerland.

Abstract

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.