Background/Purpose: Accurate diagnosis of cardiovascular involvement in systemic lupus erythematosus (SLE) remains challenging, because echocardiography (echo), the cornerstone tool used, has serious limitations. We hypothesized that cardiovascular magnetic resonance (CMR) detects cardiac lesions in SLE patients, missed by echo.

Methods: Between 2005-2015, eighty asymptomatic SLE patients, aged 37±6 yrs, 72F/8M with normal echo, under treatment with antimalarials, have been evaluated using a 1.5 T system. LV-RV ejection fraction, T2 ratio (oedema imaging) and late gadolinium enhancement (LGE) (fibrosis imaging) were assessed. Acute and chronic lesions were characterised as LGE-positive plus T2>2 or T2<2, respectively. According to LGE, lesions were characterized as: a) diffuse subendocardial, b) subepicardial and c) subendocardial /transmural, due to vasculitis, myocarditis and myocardial infarction, respectively

Results: Abnormal CMR findings were identified in 22/80 (27.5 %) asymptomatic SLE patients with normal echo, including 4/22 with recent onset of silent myocarditis, 9/22 with past myocardial infarction (6 inferior and 3 anterior subendocardial infarction), 5/22 with past myocarditis (subepicardial scar in inferolateral wall) and 4/22 with diffuse subendocardial fibrosis (DSF), due to vasculitis. No correlation between CMR findings and inflammatory indices was identified.

Conclusion: CMR in asymptomatic SLEs with normal echo can assess occult cardiac lesions including vasculitis, myocarditis and myocardial infarction, missed by echo that can influence both rheumatic and cardiac treatment and further risk stratification; therefore, it should be included in the diagnostic algorithm of SLE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cardiovascular-disease-in-systemic-lupus-erythematosus-the-road-to-hell-is-paved-with-good-intentions/