Complementary role of cardiovascular imaging and laboratory indices in early detection of cardiovascular disease in systemic lupus erythematosus

Abstract

Background Cardiovascular disease (CVD) has been documented in >50% of systemic lupus erythematosus (SLE) patients, due to a complex interplay between traditional risk factors and SLE-related factors. Various processes, such as coronary artery disease, myocarditis, dilated cardiomyopathy, vasculitis, valvular heart disease, pulmonary hypertension and heart failure, account for CVD complications in SLE. Methods Electrocardiogram (ECG), echocardiography (echo), nuclear techniques, cardiac computed tomography (CT), cardiovascular magnetic resonance (CMR) and cardiac catheterization (CCa) can detect CVD in SLE at an early stage. ECG and echo are the cornerstones of CVD evaluation in SLE. The routine use of cardiac CT and nuclear techniques is limited by radiation exposure and use of iodinated contrast agents. Additionally, nuclear techniques are also limited by low spatial resolution that does not allow detection of sub-endocardial and sub-epicardial lesions. CCa gives definitive information about coronary artery anatomy and pulmonary artery pressure and offers the possibility of interventional therapy. However, it carries the risk of invasive instrumentation. Recently, CMR was proved of great value in the evaluation of cardiac function and the detection of myocardial inflammation, stress-rest perfusion defects and fibrosis. Results An algorithm for CVD evaluation in SLE includes clinical, laboratory, ECG and echo assessment as well as CMR evaluation in patients with inconclusive findings, persistent cardiac symptoms despite normal standard evaluation, new onset of life-threatening arrhythmia/heart failure and/or as a tool to select SLE patients for CCa. Conclusions A non-invasive approach including clinical, laboratory and imaging evaluation is key for early CVD detection in SLE.

Early diagnosis of cardiac involvement in systemic lupus erythematosus via global longitudinal strain (GLS) by speckle tracking echocardiography

“…Cardiac involvement in SLE is frequently diagnosed with sensitive and noninvasive imaging methods such as echocardiography. 17-20 Transthoracic echocardiography is applied to assess cardiac involvement in many autoimmune diseases such as SLE and rheumatoid arthritis. Most cardiac involvements in SLE are silent clinically, but they can cause significant illness and death.…”

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

“…An algorithm for the cardiovascular work-up of SLE patients was recently proposed together with a systematic review by Mavrogeni et al[ 40 ]. In this algorithm, echocardiography remained the cornerstone for non-invasive techniques for the assessment of cardiovascular involvement since it is inexpensive, widely available and can guide further work-up especially in acute clinical situations.…”

“…In these situations, CMR could guide further diagnostic evaluation and treatment and could reduce exposure to radiation. The Achilles’ heel of CMR remains the lower availability and the higher costs [ 40 ]. Especially in the asymptomatic or oligosymptomatic SLE patient results of the CMR may be used to rule out structural cardiovascular disease or to guide the necessity of further evaluation like coronary angiography in case of relevant ischemia related to the territory of a coronary artery.…”

CMR in Pericardial Diseases - an Update

“…CMR is also able to play a pivotal role in the management of pericarditis due to specific conditions. The most representative example is the autoimmune myopericarditis [56]. By using T1 and T2 mapping techniques as well as LGE an early diagnosis of the heart involvement in autoimmune disease such as SLE, Sarcoidosis or Rheumatoid Arthritis is possible [19].…”