Cardiovascular magnetic resonance detects silent heart disease missed by echocardiography in systemic lupus erythematosus

Abstract

Background Accurate diagnosis of cardiovascular involvement in systemic lupus erythematosus (SLE) remains challenging, due to limitations of echocardiography. We hypothesized that cardiovascular magnetic resonance can detect cardiac lesions missed by echocardiography in SLE patients with atypical symptoms. Aim To use cardiovascular magnetic resonance in SLE patients with atypical symptoms and investigate the possibility of silent heart disease, missed by echocardiography. Patients/methods From 2005 to 2015, 80 SLE patients with atypical cardiac symptoms/signs (fatigue, mild shortness of breath, early repolarization and sinus tachycardia) aged 37 ± 6 years (72 women/8 men), with normal echocardiography, were evaluated using a 1.5 T system. Left and right ventricular ejection fractions, T2 ratio (oedema imaging) and late gadolinium enhancement (fibrosis imaging) were assessed. Acute and chronic lesions were defined as late gadolinium enhancement-positive plus T2>2 and T2<2, respectively. Lesions were characterized according to late gadolinium enhancement patterns as: diffuse subendocardial, subepicardial and subendocardial/transmural, due to vasculitis, myocarditis and myocardial infarction, respectively. Results Abnormal cardiovascular magnetic resonance findings were identified in 22/80 (27.5%) of SLE patients with normal echocardiography, including 4/22 with recent silent myocarditis, 5/22 with past myocarditis (subepicardial scar in inferolateral wall), 9/22 with past myocardial infarction (six inferior and three anterior subendocardial infarction) and 4/22 with diffuse subendocardial fibrosis due to vasculitis. No correlation between cardiovascular magnetic resonance findings and inflammatory indices was identified. Conclusions Cardiovascular magnetic resonance in SLE patients with atypical cardiac symptoms/signs and normal echocardiography can assess occult cardiac lesions including myocarditis, myocardial infarction and vasculitis that may influence both rheumatic and cardiac treatment.

Combined Brain-Heart Magnetic Resonance Imaging in Autoimmune Rheumatic Disease Patients with Cardiac Symptoms: Hypothesis Generating Insights from a Cross-Sectional Study

“…We have previously reported that occult CMR lesions, including myocardial odema, myocarditis, diffuse subendocardial fibrosis and myocardial infarction are not unusual in treatment naïve ARD patients, and may be reversible after appropriate treatment [46]. Similarly, cardiac lesions, missed by echocardiography, were detected by CMR in SLE patients in another study by our group [47]. The CMR findings in the current ARD cohort are thus in agreement with previous literature by our group and others regarding the spectrum of CMR lesions in ARDs [23,[31][32][33].…”

“…As such, this demonstrates the need for a combined brain and heart MRI examination in ARD patients with cardiac symptoms, seeing as disease progression may evolve differently in the two organs. Notably, our group has previously reported that CMR findings are independent of C-reactive protein levels in ARD patients [47,51,52], often rendering biomarker-based pre-selection of patients for CMR examinations problematic. This would explain the current findings and suggests that such inflammatory biomarkers might have greater utility in evaluating brain involvement than cardiac involvement, although this needs to be corroborated by future independent studies.…”

Fragmented QRS complex in patients with systemic lupus erythematosus at the time of diagnosis and its relationship with disease activity

“…Depending on the patient's condition, the use of CMR can be restricted. Cardiac involvement in the absence of typical cardiac symptoms detected via CMR can be missed on transthoracic echocardiography (TTE); therefore, a new routine indicator is required [10].…”

Морфологічні Зміни Серця У Тварин З Експериментальним Системним Червоним Вовчаком

“…У переважній більшості випад-ків СЧВ виявляють зміни систоло-діастолічної функції лівого шлуночка [4,5], а у деяких пацієн-тів також дисфункції правого шлуночка і перед-сердя [6, 7]. Добре відомі спостереження рапто-вої смерті хворих на СЧВ внаслідок гострої серце-вої недостатності [8].Ознаки ураження серця при СЧВ у вигляді міо кардиту, коронариту, інфаркту міокарда, пору-шень кардіального ритму (процесів збудливості й електричної провідності) вельми неспецифічні, часто-густо складні для діагностики, а різні ланки їх патогенезу вимагають уточнення [9][10][11]. Особ-ливої значущості набуває вовчаковий ендокар-дит Лібмана-Сакса [12, 13] з формуванням кла-панних вад серця [14].…”

“…Ознаки ураження серця при СЧВ у вигляді міо кардиту, коронариту, інфаркту міокарда, пору-шень кардіального ритму (процесів збудливості й електричної провідності) вельми неспецифічні, часто-густо складні для діагностики, а різні ланки їх патогенезу вимагають уточнення [9][10][11]. Особ-ливої значущості набуває вовчаковий ендокар-дит Лібмана-Сакса [12, 13] з формуванням кла-панних вад серця [14].…”