Background Systemic lupus erythematosus (SLE) is associated with increased cardiovascular disease either due to disease per se or to non-SLE related causes. We hypothesized that cardiac tissue characterization by cardiovascular magnetic resonance (CMR) may aid in clarifying the pathophysiology of heart failure in SLE.
Methods Thirty-two SLE patients (29 women), aged 29±7 yrs (range 25-40), after recent X-Ray coronary angiography (<30 days), due to new-onset HF NYHA I-II, were consecutively evaluated by CMR, including LV function, STIR T2 and late gadolinium enhanced (LGE) images.
Results T2 ratio>2 and patchy, epi/endo-myocardial LGEs with a total extent of 7±2% LV, due to acute myocarditis, were identified in 5/31 (16%) patients. LV function impairment, but without inflammation or fibrosis, due to dilated cardiomyopathy (DCM), was also found in 5 other patients (16%). A transmural myocardial scar (6 inferior and 5 anteroseptal), due to myocardial infarction, was evident in other 11/32 patients (34%), with an extent of 25±3% LV. Notably, diffuse subendocardial fibrosis with an extent of 34±3% LV, due to vasculitis, was revealed in 9 patients (29%). Finally, aortic valve stenosis and mitral valve regurgitation, due to Libman- Sacks endocarditis, were diagnosed in the remaining 2 patients (6%). No mixed pathology was observed in any patient. The presence of LGE, denoting myocardial fibrosis, correlated significantly with longer disease duration, higher erythrocyte sedimentation rate and the presence of anti-phospholipid antibodies Abnormal X-Ray coronary angiography (3, 5 and 3 patients having 1, 2 and 3 vessel disease, respectively) was found only in those patients with transmural myocardial scar, which followed the distribution of diseased vessels.
Conclusions Heart failure in patients with SLE is due to various causes, including myocarditis, dilated cardiomyopathy, coronary artery disease, vasculitis and/or valvular disease. Assessment of the pathophysiologic background by CMR may facilitate the differential diagnosis and patients' risk stratification.
Disclosure of Interest None declared
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