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

Burkard, Thilo; Trendelenburg, Marten; Daikeler, Thomas; Hess, Christoph; Bremerich, Jens; Haaf, Philip; Buser, Peter; Zellweger, Michael J.

doi:10.1371/journal.pone.0202105

Cited by 45 publications

(34 citation statements)

References 38 publications

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“…Both SLE and the presence of aPL increase the risk for valvular heart disease. 58 59 Myocarditis is rare yet increasingly recognised in SLE after the advent of heart MRI and use…”

Section: Pulmonary Hypertension and Involvement Of The Heartmentioning

confidence: 99%

Update οn the diagnosis and management of systemic lupus erythematosus

et al. 2020

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Clinical heterogeneity, unpredictable course and flares are characteristics of systemic lupus erythematosus (SLE). Although SLE is—by and large—a systemic disease, occasionally it can be organ-dominant, posing diagnostic challenges. To date, diagnosis of SLE remains clinical with a few cases being negative for serologic tests. Diagnostic criteria are not available and classification criteria are often used for diagnosis, yet with significant caveats. Newer sets of criteria (European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2019) enable earlier and more accurate classification of SLE. Several disease endotypes have been recognised over the years. There is increased recognition of milder cases at presentation, but almost half of them progress overtime to more severe disease. Approximately 70% of patients follow a relapsing-remitting course, the remaining divided equally between a prolonged remission and a persistently active disease. Treatment goals include long-term patient survival, prevention of flares and organ damage, and optimisation of health-related quality of life. For organ-threatening or life-threatening SLE, treatment usually includes an initial period of high-intensity immunosuppressive therapy to control disease activity, followed by a longer period of less intensive therapy to consolidate response and prevent relapses. Management of disease-related and treatment-related comorbidities, especially infections and atherosclerosis, is of paramount importance. New disease-modifying conventional and biologic agents—used alone, in combination or sequentially—have improved rates of achieving both short-term and long-term treatment goals, including minimisation of glucocorticoid use.

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“…Both SLE and the presence of aPL increase the risk for valvular heart disease. 58 59 Myocarditis is rare yet increasingly recognised in SLE after the advent of heart MRI and use…”

Section: Pulmonary Hypertension and Involvement Of The Heartmentioning

confidence: 99%

Update οn the diagnosis and management of systemic lupus erythematosus

et al. 2020

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“…Cardiac magnetic resonance imaging demonstrating late gadolinium enhancement may be relatively specific for diagnosing myocardial inflammation, i.e., myocarditis. 5,24 However, it is an evolving technique with some studies suggesting high rates of subclinical myocardial inflammation. Endomyocardial biopsies are rarely feasible in sick patients and have poor sensitivity.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of antiphospholipid antibodies in patients with overt myocardial dysfunction in systemic lupus erythematosus. A case-control study

Gawalkar

Bahl

Ahluwalia

et al. 2020

Lupus

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Background Small case-series have reported overt myocardial dysfunction to be associated with positive antiphospholipid antibodies in patients of systemic lupus erythematosus (SLE). However, there is no case-control study that has examined this association. Methods This case-control study recruited patients of SLE (fulfilling SLICC criteria) with overt myocardial dysfunction as cases and those without this as controls. Overt myocardial dysfunction was defined by echocardiography as global left ventricular dysfunction and reduced ejection fraction (<50%). Those patients with a prior diagnosis of anti-phospholipid antibody syndrome, coronary artery disease, rheumatic heart disease or severe pulmonary artery hypertension were excluded. Antibodies tested included lupus anticoagulant, anticardiolipin antibodies (IgM and IgG) and anti-beta 2 glycoprotein 1 antibodies (IgM and IgG). Patients with positive tests underwent repeat testing for persistent positivity after 12 weeks. Results This study included 51 patients (21 cases and 30 controls) having a mean (SD) age of 33 (13.3) years, and disease duration (median, IQR) of 28 months (12−38 months). The mean ejection fraction of cases was 31.7 (9.3)% while that of controls was 55.7 (1.7)% (p = 0.03). The frequency (percentage) of positive antiphospholipid antibodies was not significantly different between cases and controls (43%, 40%, p = 0.8). The frequency (percentage) of anti-cardiolipin antibody was also not significant between the groups (38%, 37%, p = 0.57). Serositis and leucopenia were more prevalent in SLE patients with myocardial dysfunction (p = 0.005). Conclusion This study did not find any significant association of anti-phospholipid antibodies with overt myocardial dysfunction in patients of SLE.

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“…Cardiac MRI has also become an important diagnostic modality in detecting myocardial disease in lupus [ 14 – 17 ]. Even in the absence of TTE abnormalities, cardiac MRI can demonstrate lesions, including myocarditis and vasculitis as well as hemodynamic parameters such as ventricular stiffness [ 14 – 16 ].…”

Section: Discussionmentioning

confidence: 99%

Elevated Cardiac Troponin T in Patients with Lupus Myositis Presenting with Noncardiac Chest Pain

Katz

Kolasinski

Sundaram

et al. 2020

Case Reports in Rheumatology

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Patients with systemic lupus erythematosus (SLE) presenting with chest pain pose a unique diagnostic challenge, with causes ranging from cardiopulmonary disease to esophageal disorders and musculoskeletal chest wall pain. The most common biomarkers for myocardial injury are cardiac troponin T and I (cTnT and cTnI) due to their high sensitivity for the early detection of myocardial infarction. In the idiopathic inflammatory myopathies, cTnT is commonly elevated, and this reflects skeletal muscle breakdown rather than myocardial damage. Similar observations have not been reported in SLE myositis to date. We present two cases of patients with SLE and associated myositis who presented with chest pain and elevated cTnT. Both patients had a normal cTnI, transthoracic echocardiogram, and cardiac magnetic resonance imaging, likely indicating noncardiac chest pain. Clinicians should be aware that the specificity of cTnT might be lower in SLE myositis and that cTnI elevation may be more specific in detecting myocardial insult.

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

Cited by 45 publications

References 38 publications

Update οn the diagnosis and management of systemic lupus erythematosus

Update οn the diagnosis and management of systemic lupus erythematosus

Prevalence of antiphospholipid antibodies in patients with overt myocardial dysfunction in systemic lupus erythematosus. A case-control study

Elevated Cardiac Troponin T in Patients with Lupus Myositis Presenting with Noncardiac Chest Pain

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