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  • Poster presentation
  • Open Access

Prevalence of cardiac morphological and functional alterations in systemic lupus erythematosus patients with a low disease activity

  • 1,
  • 2 and
  • 1
Journal of Cardiovascular Magnetic Resonance201315 (Suppl 1) :P94

https://doi.org/10.1186/1532-429X-15-S1-P94

  • Published:

Keywords

  • Systemic Lupus Erythematosus
  • Cardiovascular Magnetic Resonance
  • Systemic Lupus Erythematosus Patient
  • Late Gadolinium Enhancement
  • Functional Alteration

Background

Cardiac involvement in systemic lupus erythematosus (SLE) is a common complication and is associated with a considerable morbidity and mortality in these patients. As affected individuals often present with subclinical or non-specific symptoms the betimes confirmation of cardiac manifestations is challenging. Cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) is the current gold-standard for non-invasive tissue characterization as well as for the evaluation of systolic and diastolic function. In this study we assessed the cardiac morphology and function in SLE patients with low disease activity.

Methods

We studied twenty-nine SLE patients (3 male, 26 female) fulfilling the SLE diagnostic criteria of the American College of Rheumatology and compared them to thirty age-matched healthy volunteers. All patients were in a stable clinical condition and only patients with a low disease activity (SLEDAI Index < 5) were included. All of them received an individually optimized medication. CMR images were acquired on a 1.5 T whole-body MRI (Achieva, Philips Healthcare, Best, The Netherlands) using a 32-element cardiac phased-array coil. Short and long axis views were obtained applying a standard clinical steady-state free-precession sequence and LGE CMR imaging was performed (Gadolinium-DTPA 0.2 mmol/kg body weight, Magnevist, Schering, Berlin, Germany) in 27 patients. Left and right ventricular (LV, RV) end-diastolic and end-systolic volumes (EDV, ESV), stroke volume (SV), ejection fraction (EF) as well as the mitral/tricuspid annular plane systolic excursion (M/TAPSE) and LV wall mass were measured.

Results

SLE patients and healthy controls had comparable demographic and clinical characteristics. SLE patients had significantly higher LV-EDV, LV-ESV and LV-EF. LV-SV and MAPSE did not differ significantly between patients and healthy controls. However SLE patients had significantly higher RV-EDV, RV-ESV, RV-SV, RV-EF and TAPSE values. LV mass showed no significant differences. Nineteen of twenty-seven assessed patients (70%) showed LGE CMR as a sign of myocardial involvement.

Conclusions

Even in SLE patients with a low disease activity there is a high prevalence of myocardial and functional alterations. Especially the RV function is affected which could be due to early onset pulmonary manifestations of SLE. Regarding the high morbidity and mortality of cardiac complications in SLE patients, CMR may be an important non-invasive method for the early diagnosis of cardiopulmonary involvement.

Funding

none
Table 1

Comparison of SLE patients to healthy controls

 

SLE patients (n=29)

Healthy controls (n=30)

 

LV EF (%)

64.1±9.4

68.4±5.4

p<0.05

LV EDV (ml)

152.7±31.0

129.1±30.9

p<0.01

LV ESV (ml)

56.3±24.3

41.7±16.0

p<0.01

LV SV (ml)

96.5±19.5

87.3±16.8

p=n.s.

LV Cardiac output (l/min)

7.0±1.9

6.1±1.2

p<0.05

MAPSE (mm)

12.9±2.7

14.6±4.1

p=n.s.

LV EDV/BSA (ml/m2)

85.7±17.5

73.6±14.2

p<0.01

LV ESV/BSA (ml/m2)

31.8±15.2

23.8±8.3

p<0.05

LV SV/BSA (ml/m2)

53.9±9.6

49.8±7.0

p=n.s.

RV EF (%)

52.9±9.0

60.2±7.4

p<0.01

RV EDV (ml)

178.0±29.5

127.1±34.6

p<0.0001

RV ESV (ml)

83.8±20.6

50.8±17.3

p<0.0001

RV SV (ml)

94.2±24.0

76.3±21.2

p<0.01

RV Cardiac output (l/min)

6.8±2.1

5.3±1.6

p<0.01

TAPSE (mm)

23.3±6.0

20.1±4.7

p<0.05

RV EDV/BSA (ml/m2)

52.5±11.5

43.5±10.9

p<0.01

RV ESV/BSA (ml/m2)

47.2±12.7

28.9±8.8

p<0.0001

RV SV/BSA (ml/m2)

52.5±11.5

43.5±10.9

p<0.001

Wall mass (g)

73.1±19.2

63.3±20.9

p=n.s.

Wall mass/BSA (g/m2)

40.7±9.0

35.9±9.5

p=n.s.

Table 2

Demographic and clinical characteristics

 

SLE patients (n=29)

Healthy controls (n=30)

 

Age (years)

44.7±13.4

44.7±11.1

p=n.s

Sex (female)

26/29 (89.7%)

27/30 (90.0%)

p=n.s

Weight (kg)

71.6±15.2

66.8±11.2

p=n.s

BMI (kg/m2)

25.9±4.7

23.9±4.0

p=n.s

BSA (m2)

1.79±0.19

1.74±0.15

p=n.s

Heart rate (bpm)

70.9±12.6

66.5±9.5

p=n.s

Blood pressure systolic (mmHg)

122.7±10.7

123.8±15.8

p=n.s

Blood pressure diastolic (mmHg)

74.2±11.5

75.6±6.9

p=n.s

Authors’ Affiliations

(1)
Department of Cardiology, University of Heidelberg, Heidelberg, Germany
(2)
School of Medicine of Ribeirao Preto University of Sao Paulo, Sao Paulo, Brazil

Copyright

© Andre et al; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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