Session Type: Abstract Submissions (ACR)
Myocarditis is an uncommon manifestation with important morbidity and mortality in patients with Systemic Lupus Erythematosus (SLE). There are scant information about this manifestation that comes from case series, which include no more than 24 patients. Also, there are not a uniform definition about the criteria for the diagnosis of this manifestation in SLE, and only in few reports the diagnosis was supported by cardiac magnetic resonance (CMR).
Retrospective study of all cases of myocarditis seen in a single center between 2005 and 2014. Patients with diagnosis of SLE according to the updated 1982 ACR criteria, who met the expanded criteria for myocarditis and had CMR compatible with the diagnosis were included.
The objective of the study was to describe the clinical and laboratorial manifestations, and electrocardiographic, echocardiographic and CMR findings of these patients.
Twenty five patients (24 women, 96%), with a mean age of 29.38 ± 11.36 years, and who presented 26 episodes of myocarditis were included. The mean time to development of myocarditis after SLE diagnosis was 11.5 months (IQR 0-31.2%). The main clinical and imaging findings are shown in tables 1 and 2.
During the episode of myocarditis the activity of SLE at diagnosis measured by SLEDAI was of 8.77 (IQR 4-12). Patients had a SLICC Damage Index at diagnosis of 1.43 ± 1.6. Nine of 26 patients (35%) required admission to the ICU and 6 of 26 (23%) patients were treated with inotropics. There were no deaths during the acute episode, but 4 patients died during the follow-up, three of them secondary to infections. All patients were treated with prednisone, mean dose 50 ± 12 mg/day.
Follow-up MRI was performed on 10 patients, the mean initial LVEF was 49.2% ± 9.2 vs 61% ± 8.1(p=0.007). The SLEDAI score at follow-up was of 2 points (IQR 0-6), and the SLICC Damage Index at follow-up was of 1.71 ± 1.82.
Myocarditis is a severe manifestation of SLE. CMR is a useful study in the diagnosis of myocarditis that can evaluate some parameters that are not detectable in echocardiography e.g., valvulitis, edema, hyperemia and myocardial fibrosis. Further studies are needed to determine the role of CMR and currently follow-up studies are undergoing at our Institute in SLE patients with myocarditis.
M. D. C. Zamora Medina,
J. Rosas Saucedo,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/lupus-myocarditis-clinical-echocardiographic-and-magnetic-resonance-characteristics/