Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose
Cardiac complications of SLE are common and include both acute and chronic manifestations: pericarditis, myocarditis, valvular disease, pulmonary hypertension, atherosclerosis, ischemic and non-ischemic cardiomyopathy. Cardiovascular magnetic resonance (CMR) imaging is a non-invasive, non-radiating imaging modality which can evaluate cardiac function and structure, myocardial inflammation, ischemia, and fibrosis. In this study we sought to assess indications for CMR use and CMR findings in SLE patients.
Methods
Chart review was performed for all patients with SLE diagnosis who underwent CMR for clinical indications from 2004 to 2014 at a single academic center. CMR results, cardiac risk factors, medications, SLE history, laboratory results, SLEDAI-2K (within 30 days of CMR) were recorded. Descriptive statistics were performed.
Results
During this time period, 31 SLE patients underwent 48 CMR. The patients were 45 ± 11.7 years, 77% female, duration SLE 9.5 ± 9.5 years, SLEDAI-2K5.5 ± 5.9, and 13% had antiphospholipid antibody syndrome. (Table 1). The following cardiovascular risk factors were present: diabetes mellitus (23%), hypertension (58%), dyslipidemia (16%), congestive heart failure (16.1%), current smoker (27%), history of myocardial infarction (6%). Clinical indications for obtaining CMR were chest pain (40%), dyspnea (4%), abnormal echocardiogram (31%), arrhythmia (4%) and other/unknown (12%). Half of the patients who underwent CMR stress testing had abnormal perfusion (Table 2). The most common abnormalities on non-stress CMR testing included abnormal myocardial T2 signal (29.8%), late gadolinium enhancement (21.3%), pericardial thickening (14.6%), and valvular abnormalities (21.7% aortic, 23.9% mitral, 17.4% tricuspid).
Conclusion
Cardiac complications of SLE are common and impart significant morbidity and mortality. In this study, CMR imaging identified several abnormalities not evident on other cardiovascular (CV) imaging modalities including increased T2 signal in myocardium (suggesting myocardial inflammation) and late gadolinium enhancement (suggesting fibrosis from prior ischemia or inflammation). CMR allows simultaneous evaluation of cardiac function, structure, inflammation, and fibrosis and, with stress imaging, ischemia. As SLE cardiac complications are myriad, CMR is a promising tool to assess the breadth of potential CV complications in the SLE patient presenting with CV symptoms.
Table 1 SLE Participant Characteristics
|
Age, mean ± SD years |
44.9 ± 11.6 |
|
Sex, no. (%) female |
31 (77.4%) |
|
SLE Characteristics |
|
|
Duration SLE mean ± SD years |
9.52 ± 8.8 |
|
SLEDAI-2K (within 30 days of CMR), mean ± SD |
5.5 ± 5.9 |
|
History of lupus nephritis, no. (%) |
5/31 (16.7%) |
|
History of antiphospholipid antibody syndrome, no. (%) |
4/31 (12.9%) |
|
History of pericarditis, no. (%) |
8/31 (28.8%) |
|
History of positive anti-dsDNA antibody, no. (%) |
15/25 (60.0%) |
|
History of positive anti-Smith antibody, no. (%) |
14/31 (58.3%) |
|
Cardiovascular History |
|
|
Diabetes mellitus, no. (%) |
7/31 (22.6%) |
|
History of hypertension, no. (%) |
18/31 (58.1%) |
|
History of congestive heart failure, no. (%) |
5/31 (16.1%) |
|
History of ischemic stroke, no. (%) |
3 /31 (9.7%) |
|
History of myocardial infarction, no. (%) |
2/31 (6.5%) |
|
History of dyslipidemia, no. (%) |
5/31 (16.1%) |
|
Current smoker, no. (%) |
8/31 (26.7%) |
|
Former smoker, no. (%) |
10/30 (33.3%) |
|
ECG abnormal within 30 days of CMR,no. (%) |
21/38 (55.3%) |
|
History of abnormal echocardiogram, no. (%) |
40/45 (88.9%) |
|
Medications at time of CMR |
|
|
Hydroxychloroquine, no. (%) |
28/48 (65.1%) |
|
No prednisone, no. (%) |
15/48 (35.0%) |
|
Azathioprine, no. (%) |
7/48 (16.3%) |
|
Mycophenolate mofetil, no. (%) |
5/48 (11.6%) |
|
Methotrexate, no. (%) |
6/48 (13.9%) |
|
Leflunomide, no. (%) |
4/48 (9.3%) |
|
Belimumab, no. (%) |
2/48 (4.6%) |
|
Cyclophosphamide, no. (%) |
2/48 (4.6%) |
|
Statin, no. (%) |
20/48 (45.4%) |
|
Other lipid lowering agent, no. (%) |
4/48 (9.3%) |
|
Aspirin, no. (%) |
21/48 (48.8%) |
|
Warfarin, no. (%) |
8/44 (18.2%) |
|
ACE-inhibitor , no. (%) |
9/48 (20.9%) |
|
Angiotensin receptor blocker, no. (%) |
12/48 (27.9%) |
|
Calcium channel blocker, no. (%) |
15/48 (34.8%) |
|
Diuretic, no. (%) |
24/44 (54.5%) |
|
Laboratory values within 30 days of CMR |
|
|
Erythrocyte sedimentation rate elevated, no. (%) |
18/27 (66.7%) |
|
C-reactive protein elevated, no. (%) |
9/22 (40.9%) |
|
Troponin I elevated, no. (%) |
3/20 (15.0%) |
|
Creatinine kinase elevated, no. (%) |
3/12 (25.0%) |
|
Brain natriuretic peptide elevated, no. (%) |
5/14 (35.7%) |
|
Hemoglobin, mean ± SD, mg/dL |
10.4 ± 2.2 |
|
Serum albumin, mean ± SD, g/dL |
3.2 ± 0.8 |
|
Serum creatinine, mean ± SD, mg/dL |
1.2 ± 2.0 |
|
Abbreviations : ACE = angiotensin converting enzyme; CMR = cardiac magnetic resonance imaging; dsDNA = double stranded DNA; ECG = electrocardiogram; SLE = systemic lupus erythematosus, SLEDAI = systemic lupus erythematosus disease activity index
|
|
Table 2: Cardiac Magnetic Resonance (CMR) Imaging in SLE Patients
|
Clinical Indications for Obtaining CMR |
N=48 |
|
Chest pain, no. (%) |
19 (39.5%) |
|
Dyspnea, no. (%) |
2 (4.2%) |
|
Abnormal echocardiogram, no. (%) |
15 (31.0%) |
|
Arrhythmia, no. (%) |
2 (4.2%) |
|
Other/not available, no. (%) |
6 (12.5%) |
|
CMR Results |
|
|
CMR stress testing performed, no. (%) |
11/48 (22.9%) |
|
CMR stress with abnormal perfusion, no. (%) |
5/36 (13.9%) |
|
LV normal , no. (%) |
40/46 (87.0%) |
|
LV ejection fraction ± SD, % |
56.4 ±11.9 |
|
LV diastolic dysfunction present, no. (%) |
3/46 (6.5%) |
|
Abnormal LV peak circumferential strain, no. (%) |
2/46 (4.4%) |
|
RV function normal, no. (%) |
44/46 (95.6%) |
|
Myocardium with abnormal T2 signal, no. (%) |
14/47 (29.8%) |
|
Pericardial thickening, no. (%) |
7/48 (14.6%) |
|
Pericardial enhancement, no. (%) |
1/47 (2.1%) |
|
Late gadolinium enhancement, no. (%) |
10/47 (21.3%) |
|
Pulmonary artery enlargement, no. (%) |
2/46 (4.4%) |
|
Abnormal aortic valve, no. (%) |
10/46 (21.7%) |
|
Abnormal mitral valve, no. (%) |
11/46 (23.9%) |
|
Abnormal pulmonic valve, no. (%) |
0% |
|
Abnormal tricuspid valve, no. (%) |
8/46 (17.4%) |
|
Valvular vegetation present, no. (%) |
0% |
|
Abbreviations: CMR = cardiac magnetic resonance imaging; LV = left ventricle; RV = right ventricle
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Disclosure:
A. Meara,
None;
N. Dhillon,
None;
K. Fisher,
None;
P. Jensen,
None;
S. P. Ardoin,
None.
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