Session Information
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose : Cardiovascular disease (CVD) remains a leading cause of death in SLE. Lupus patients have a 2-3 fold increased risk to develop heart failure compared with matched controls. Both traditional CVD risk factors and SLE itself play an important role in its development and associated excess deaths. Interest has emerged to study potential underlying mechanisms such as the presence of myocardial inflammation in attempts for early intervention when warranted. This study was initiated to evaluate the prevalence of myocardial inflammation in SLE using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT), and the association of FDG uptake with disease characteristics in SLE patients without clinical CVD.
Methods: Patients <45 years old in the Columbia University Lupus Cohort without clinical evidence of CVD, history of antiphospholipid antibody syndrome, or cardiac related symptoms were invited to participate. All patients met the 1997 ACR SLE Classification criteria. Ten SLE patients underwent cardiac FDG-PET/CT imaging for evaluation of myocarditis by standardized methods. Demographics, SLE-specific characteristics, and CVD risk factors were ascertained. Coronary artery disease was evaluated by the Agatston coronary artery calcium score. The prevalence of myocarditis and its association with SLE-disease characteristics and conventional CVD risk factors was evaluated.
Results: Table 1 depicts the patient characteristics. The mean age was 33±7 years, 80% were female, 80% Hispanic and 20% were non-Hispanic Black. The median SLEDAI-2K and SLICC SDI scores were 2 (1-4) and 0 (0-0), respectively. Median SLE disease duration was 11 years (7-15). None of the patients had hypertension, diabetes, or smoked. Non-specific ST-T abnormalities were seen in 50% of the patients. The mean ejection fraction was 64±4%. Three of the ten patients (30%) had increased FDG myocardial uptake, with a diffuse pattern noted in all (Figure 1). No SLE-specific characteristics were associated with this outcome (Table 1).
Conclusion: This pilot study shows that myocarditis, identified by myocardial FDG-PET uptake, is prevalent in SLE patients without clinical CVD despite low disease activity. This supports the use of FDG-PET/CT imaging in the diagnosis of myocarditis in SLE and to further evaluate the prevalence of myocardial involvement in lupus. Table 1. Patient Characteristics and Cardiovascular diagnostic tests (n=10).
|
Total (n=10) |
Myocarditis (n= 3) |
No Myocarditis (n= 7) |
p-value |
|
| Age, years, mean ± SD |
33 ± 7 |
33 ± 2 |
33 ± 8 |
0.97 |
| Female, n (%) |
8 (80%) |
2 (66%) |
6 (86%) |
1.0 |
| Race/Ethnicity |
|
|
|
|
| Non-Hispanic White, n (%) |
0 |
0 |
0 |
1.0 |
| Non-Hispanic Black, n (%) |
2 (20%) |
0 |
2 (28%) |
1.0 |
| Hispanic, n (%) |
8 (80%) |
3 (100%) |
5 (62%) |
0.47 |
|
|
|
|
|
|
|
|
|
|
|
|
| SLE duration, years, median (IQR) |
11 (7-15) |
10 (2-15) |
12 (7-16) |
0.58 |
| ANA, n (%) |
10 (100%) |
3 (100%) |
7(100%) |
1.0 |
| Anti-ds-DNA, n (%) |
6 (60%) |
1 (33%) |
5 (71%) |
0.5 |
| Anti-ds-DNA titer, median (IQR) |
56 (17-116) |
21 (7-193) |
77 (17-116) |
0.66 |
| SSA, n (%) |
5 (50%) |
2 (67%) |
3 (43%) |
1.0 |
| SSB, n (%) |
3 (30%) |
0 |
3 (43%) |
0.47 |
| Lupus anticoagulant, n (%) |
1 (10%) |
0 |
1 (14%) |
1.0 |
| Anti-cardiolipin IgG/M, n (%) |
0 |
0 |
0 |
1.0 |
| Anti-b2-glycoprotein-1, n (%) |
0 |
0 |
0 |
1.0 |
|
|
|
|
|
|
| C3, mean ± SD |
97 ± 32 |
101 ± 57 |
96 ± 21 |
0.89 |
| C4, median (IQR) |
14 (11-26) |
15 (8-32) |
14 (11-36) |
1.0 |
| SLEDAI-2K, median (IQR) |
2 (1-4) |
2 (2-4) |
2 (0-5) |
0.91 |
| SLICC, median (IQR) |
0 (0-0) |
0 (0-0) |
0 (0-2) |
0.41 |
| CRP, median (IQR) |
0.9 (0.7-3.1) |
2 (0.7-3.1) |
0.9 (0.5-3.9) |
0.82 |
| ESR, median (IQR) |
24 (11-36) |
22 (8-36) |
24 (11-57) |
0.88 |
| Current prednisone, n (%) |
4 (40%) |
1 (33%) |
3 (43%) |
1.0 |
| Antimalarials, n (%) |
8 (80%) |
2 (67%) |
6 (86%) |
1.0 |
| Azathioprine, n (%) |
1 (10%) |
0 |
1 (17%) |
1.0 |
| Mycophenolate mofetil, n (%) |
4 (40%) |
1 (33%) |
3 (43%) |
1.0 |
|
|
|
|
|
|
| Current smoking, n (%) |
0 |
0 |
0 |
1.0 |
| Hypertension, n (%) |
0 |
0 |
0 |
1.0 |
| SBP, mean ± SD |
114 ± 10 |
111 ± 13 |
115 ± 9 |
0.57 |
| DBP, mean ± SD |
73 ±11 |
72 ± 15 |
74 ± 10 |
0.85 |
| Diabetes, n (%) |
0 |
0 |
0 |
1.0 |
| Total Cholesterol, mean ± SD |
167 ± 44 |
184 ± 82 |
159 ± 20 |
0.65 |
| LDL, mean ± SD |
99 ± 39 |
112 ± 77 |
93 ± 14 |
0.70 |
| HDL, mean ± SD |
53 ± 11 |
57 ± 12 |
51 ± 12 |
0.49 |
| Triglycerides, median (IQR) |
67 (48-78) |
74 (64-86) |
52 (48-78) |
0.38 |
| Elevated Troponins, n (%) |
0 |
0 |
0 |
1.0 |
| Statin use, n (%) |
1 (10%) |
1 (33%) |
0 |
0.3 |
| EKG Non-specific ST-T changes, n (%) |
5 (50%) |
2 (67%) |
3 (43%) |
1.0 |
| EKG QTc duration (ms), mean ± SD |
420 ±25 |
423 ± 11 |
419 ± 31 |
0.83 |
| Heart Rate, mean ± SD |
76 ± 7 |
72 ± 12 |
77 ±4 |
0.55 |
|
|
|
|
|
|
| CAC score, median (IQR) |
0 (0-0) |
0 (0-17) |
0 (0-0) |
0.22 |
| EF (%), mean ± SD |
64 ± 4 |
64 ± 7 |
65 ± 2 |
0.90 |
| Diffuse Myocarditis, n (%) |
3 (30%) |
3 (100%) |
– |
– |
| Focal Myocarditis, n (%) |
0 |
0 |
– |
– |
Figure 1. 18F-fluorodeoxyglucose positron emission tomography/computed tomography showing diffuse myocardial FDG uptake.
To cite this abstract in AMA style:
Geraldino-Pardilla L, Perez T, Bokhari S, Bathon J, Askanase AD. Subclinical Myocarditis in Systemic Lupus Erythematosus Patients without Cardiovascular Disease [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/subclinical-myocarditis-in-systemic-lupus-erythematosus-patients-without-cardiovascular-disease/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/subclinical-myocarditis-in-systemic-lupus-erythematosus-patients-without-cardiovascular-disease/