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. 2018 Oct 1;13(10):e0202105.
doi: 10.1371/journal.pone.0202105. eCollection 2018.

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

Thilo Burkard  1   2   3 , Marten Trendelenburg  3   4 , Thomas Daikeler  3   5 , Christoph Hess  2   3 , Jens Bremerich  3   6 , Philip Haaf  1   3 , Peter Buser  1   3 , Michael J Zellweger  1   3
Affiliations

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

Thilo Burkard et al. PLoS One. .

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.

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Conflict of interest statement

TB has received a research grant by the Research Funds of the University Hospital Basel, Basel, Switzerland, which was partially donated by Nycomed. There are no patents, products in development or marketed products to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Structural and functional abnormal CMR findings.
PE–Pericardial effusion; LGE–late gadolinium enhancement; Ischemia indicating stress-perfusion deficit.
Fig 2
Fig 2. Frequency and combinations of structural or functional abnormalities in patients with abnormal CMR.
LGE–late gadolinium enhancement; Ischemia indicating stress-perfusion deficit.
Fig 3
Fig 3. CMR and coronary angiography in one case with ischemia and coronary artery disease.
A: Short axis stress-perfusion image showing anteroseptal perfusion deficit (arrow). B: Corresponding rest-perfusion. C: Coronary angiography with significant stenoses of the left anterior descending artery including its bifurcation to the diagonal branches (arrows).
See this image and copyright information in PMC

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References

    1. Von Feldt JM. Systemic lupus erythematosus. Recognizing its various presentations. Postgrad Med. 1995;97(4):79, 83, 6 passim. . - PubMed
    1. Fors Nieves CE, Izmirly PM. Mortality in Systemic Lupus Erythematosus: an Updated Review. Curr Rheumatol Rep. 2016;18(4):21 10.1007/s11926-016-0571-2 . - DOI - PubMed
    1. Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40(9):1725 10.1002/1529-0131(199709)40:9<1725::AID-ART29>3.0.CO;2-Y . - DOI - PubMed
    1. Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1982;25(11):1271–7. . - PubMed
    1. Chen J, Tang Y, Zhu M, Xu A. Heart involvement in systemic lupus erythematosus: a systemic review and meta-analysis. Clin Rheumatol. 2016;35(10):2437–48. 10.1007/s10067-016-3373-z . - DOI - PubMed

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Grants and funding

This work was supported by a research grant from Nycomed, contributed to the Research Funds of the University Hospital Basel, Basel, Switzerland (TB). The funders had no role in study design, data collection and Analysis, decision to publish, or preparation of the manuscript.