Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose : Cardiovascular disease (CVD) is a leading cause of death in patients with SLE. Lupus patients have a 2-3 fold increased risk of heart failure compared to age matched controls. Although the mechanisms remain unclear, lupus myocarditis (LM) has been proposed as a contributor. 18F-Fluoro-Deoxyglucose Positron Emission Computed Tomography (FDG-PET/CT) imaging has emerged as a novel modality to visualize myocardial inflammation in rheumatic diseases. The current study discusses our experience with FDG-PET/CT scanning in LM.
Methods: A total of eight SLE patients diagnosed with LM by FDG-PET/CT are described in this series. Demographics, SLE-specific characteristics, and CVD risk factors were ascertained. Coronary artery disease was evaluated by the Agatston coronary calcium score and/or coronary catheterization.
Results: Eight SLE patients (mean age 43±12 years) seen at the Lupus Center for complaints of chest pain 4 (50%), intermittent shortness of breath 2 (25%) or palpitations 2 (25%) followed from November 2015 to February 2016, underwent cardiac FDG-PET/CT for evaluation of LM. Six patients were female, 4/8 were Hispanic and 4/8 were non-Hispanic Black. The median SLEDAI-2K and SLICC SDI scores were 5 (2-11) and 1.5 (0-2), respectively. Mean SLE disease duration prior to the diagnosis of LM was 11±6 years. One patient had hypertension and diabetes, and 3 patients were former or current smokers. Of the 8 patients, 1 had a history of pericarditis and 5 had prior severe lupus activity and organ involvement: 4 had lupus nephritis and 1 had CNS lupus. All patients were ANA positive, 7 ds-DNA+ and 5 were anti-SSA antibody positive. None of the patients had anti-phospholipid antibody syndrome or APL antibodies. One patient had elevated troponins and elevated pro-BNP. Electrocardiographic abnormalities were noted in all patients with 5 having non-specific ST-T changes and sinus tachycardia. Interestingly, only 5 patients had echocardiographic abnormalities: pericardial effusion in 3 (38%), global hypokinesis in 2 (25%) and valvular abnormalities 2 (25%). The mean ejection fraction was 41±16% (Table 1). On cardiac FDG-PET/CT imaging, all patients had diffuse myocardial uptake (Figure 1).
Conclusion: These data propose that cardiac FDG-PET/CT imaging has higher sensitivity than 2-D echocardiography in detecting myocardial inflammation in SLE and support the use of FDG-PET/CT in the diagnosis of myocarditis in SLE. Table 1. Diagnostic Findings of SLE patients with FDG-PET/CT diagnosed myocarditis (n=8).
|C3, mean (±SD)||84.5 ± 26.5|
|C4, mean (±SD)||16.8 ± 11.1|
|Ds-DNA Antibody titer, mean (±SD)||113.4 ±99.7|
|ESR, mean (±SD)||45.4 ± 26.6|
|CRP, mean (±SD)||5.5 ± 28.9|
|Elevated Troponin, n (%)||1 (12%)|
|Elevated Pro-BNP, n (%)||1 (12%)|
|Non-specific ST-T-wave abnormalities, n(%)||5 (63%)|
|Sinus Tachycardia, n(%)||5 (63%)|
|Right Bundle Branch Block, n(%)||2 (25%)|
|Left Atrial Dilatation, n(%)||1 (12%)|
|No abnormalities n (%)||0 (0%)|
|Ejection Fraction (EF) , mean % (±SD)||41(16.3)|
|Abnormal EF, n (%)||4 (50%)|
|Other Echocardiographic Abnormalities|
|Global hypokinesis, n(%)||2 (25%)|
|Pericardial effusion, n(%)||3 (38%)|
|Wall Motion abnormalities, n (%)||1 (12%)|
|Valvular abnormalities, n(%)||2 (25%)|
|Left atrial dilatation, n(%)||1 (12%)|
|Left Ventricular Dilatation, n(%)||1 (12%)|
|No abnormalities, n(%)||3 (38%)|
|Abnormal Coronary Angiogram (n=4)||1 (12%)|
|Coronary Calcium Score >0 (n=4)||1 (12%)|
|Diffuse myocardial uptake, n(%)||8 (100%)|
|Focal on diffuse myocardial uptake, n(%)||1 (12%)|
To cite this abstract in AMA style:Perel-Winkler A, Bokhari S, Askanase AD, Geraldino-Pardilla L. Myocarditis in Systemic Lupus Erythematosus [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/myocarditis-in-systemic-lupus-erythematosus/. Accessed March 22, 2019.
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