PMID- 32631204
OWN - NLM
STAT- MEDLINE
DCOM- 20210707
LR  - 20210707
IS  - 1477-0962 (Electronic)
IS  - 0961-2033 (Linking)
VI  - 29
IP  - 11
DP  - 2020 Oct
TI  - Myocardial injury in systemic lupus erythematosus according to cardiac magnetic 
      resonance tissue characterization: clinical and echocardiographic features.
PG  - 1461-1468
LID - 10.1177/0961203320936748 [doi]
AB  - OBJECTIVES: To determine the prevalence of myocardial injury (MInj) in systemic 
      lupus erythematosus (SLE) according to cardiac magnetic resonance (CMR) criteria. 
      To compare clinical and echocardiographic features of patients with and without 
      MInj and identify predictors of myocardial tissue characteristics according to 
      CMR. METHODS: SLE inpatients underwent CMR screening for MInj based on the Lake 
      Louise Criteria (LLC). Tissue characteristics included inflammation (increased 
      T2-weighted signal or early gadolinium enhancement ratio (EGEr)) and necrosis or 
      fibrosis (late gadolinium enhancement (LGE)). Echocardiographic parameters 
      included left (left ventricular ejection fraction (LVEF)) and right ventricular 
      function (tricuspid annular plane systolic excursion (TAPSE)), global 
      longitudinal strain (GLS), wall motion score (WMSi) and left ventricular internal 
      diameter index (LVIDi). Variables were compared with regards to the 
      presence/absence of CMR criteria. Logistic regression identified variables 
      predictive of CMR tissue characteristics. RESULTS: A hundred and six SLE patients 
      were screened of whom 49 patients were included. Fifty-seven patients were 
      excluded due to intolerance of or contraindication to CMR (27/57 due to renal 
      impairment). Twenty-three patients had CMR evidence of MInj, of which 60.9% was 
      subclinical. Inflammation occurred in 16/23 and necrosis/fibrosis in 12/23 
      patients. Patients with any evidence of MInj were more frequently anti-dsDNA 
      positive (p = 0.026) and patients fulfilling LLC for myocarditis had higher SLE 
      disease activity (p = 0.022). The LVIDi (p = 0.005), LVEF (p = 0.005) and TAPSE 
      (p = 0.011) were more abnormal in patients with an increased EGEr, whereas WMSi 
      (p = 0.002) and GLS (0.020) were more impaired in patients with LGE. On 
      multivariable logistic regression analyses, TAPSE predicted inflammation (OR: 
      0.045, p = 0.006, CI: 0.005-0.415) and GLS predicted necrosis/fibrosis (OR: 
      1.329, p = 0.031, CI: 1.026-1.722). A model including lymphocyte count, TAPSE and 
      LVIDi predicted an increased EGEr on CMR (receiver operating characteristic-curve 
      analyses: area under the curve: 0.901, p < 0.001, sensitivity: 88.9%, 
      specificity: 76.3%). CONCLUSIONS: CMR evidence of MInj frequently occurs in SLE 
      and is often subclinical. The utility of CMR in SLE is limited by a high 
      exclusion rate, mainly due to renal involvement. Models including 
      echocardiographic parameters (TAPSE, LVIDi and GLS) are predictive of CMR 
      myocardial injury. Echocardiography can be used as a cost-effective screening 
      tool with a high negative predictive value, in particular when CMR is 
      contraindicated or unavailable.
FAU - du Toit, Riette
AU  - du Toit R
AUID- ORCID: 0000-0001-9863-3102
AD  - Division of Rheumatology, Department of Medicine, Stellenbosch University and 
      Tygerberg Academic Hospital, Cape Town, South Africa.
FAU - Herbst, Phillip G
AU  - Herbst PG
AD  - Division Cardiology, Department of Medicine, Stellenbosch University and 
      Tygerberg Academic Hospital, Cape Town, South Africa.
FAU - Ackerman, Christelle
AU  - Ackerman C
AD  - Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, 
      Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa.
FAU - Pecoraro, Alfonso Jk
AU  - Pecoraro AJ
AD  - Division Cardiology, Department of Medicine, Stellenbosch University and 
      Tygerberg Academic Hospital, Cape Town, South Africa.
FAU - du Toit, Rudolf Hr
AU  - du Toit RH
AD  - Division Cardiology, Department of Medicine, Stellenbosch University and 
      Tygerberg Academic Hospital, Cape Town, South Africa.
FAU - Hassan, Karim
AU  - Hassan K
AD  - Division Cardiology, Department of Medicine, Stellenbosch University and 
      Tygerberg Academic Hospital, Cape Town, South Africa.
FAU - Joubert, LLoyd H
AU  - Joubert LH
AD  - Division Cardiology, Department of Medicine, Stellenbosch University and 
      Tygerberg Academic Hospital, Cape Town, South Africa.
FAU - Reuter, Helmuth
AU  - Reuter H
AD  - Division of Clinical Pharmacology, Department of Medicine, Stellenbosch 
      University and Tygerberg Academic Hospital, Cape Town, South Africa.
AD  - Institute of Orthopaedics and Rheumatology, Stellenbosch, South Africa.
FAU - Doubell, Anton F
AU  - Doubell AF
AD  - Division Cardiology, Department of Medicine, Stellenbosch University and 
      Tygerberg Academic Hospital, Cape Town, South Africa.
LA  - eng
PT  - Journal Article
DEP - 20200706
PL  - England
TA  - Lupus
JT  - Lupus
JID - 9204265
RN  - AU0V1LM3JT (Gadolinium)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Cross-Sectional Studies
MH  - Echocardiography
MH  - Female
MH  - Fibrosis
MH  - Gadolinium
MH  - Humans
MH  - Logistic Models
MH  - Lupus Erythematosus, Systemic/*complications/diagnosis
MH  - Lymphocyte Count
MH  - *Magnetic Resonance Imaging, Cine
MH  - Male
MH  - Myocarditis/*diagnostic imaging/etiology/*pathology
MH  - Myocardium/*pathology
MH  - Prospective Studies
MH  - Stroke Volume
MH  - Ventricular Function, Left
MH  - Young Adult
OTO - NOTNLM
OT  - Systemic lupus erythematosus
OT  - cardiovascular disease
OT  - magnetic resonance imaging
OT  - myocarditis
EDAT- 2020/07/08 06:00
MHDA- 2021/07/08 06:00
CRDT- 2020/07/08 06:00
PHST- 2020/07/08 06:00 [pubmed]
PHST- 2021/07/08 06:00 [medline]
PHST- 2020/07/08 06:00 [entrez]
AID - 10.1177/0961203320936748 [doi]
PST - ppublish
SO  - Lupus. 2020 Oct;29(11):1461-1468. doi: 10.1177/0961203320936748. Epub 2020 Jul 6.