Objective Chest pain and/or discomfort are more commonly reported by SLE patients than by their doctors. The causes for these complaints are multifactorial, but it is especially important to promptly recognize and treat heart disease, a well-documented major cause of impaired health and shortened life expectancy in SLE.

Methods SLE patients who presented with chest pain and/or discomfort were investigated using stress cardiac magnetic resonance imaging (CMR). Patients with contraindications to stress CMR were either excluded or investigated using CMR without adenosine provocation. Patients with findings at stress CMR indicating coronary artery disease (CAD) or coronary microvascular dysfunction (CMD) were referred to the cardiology department for further work-up. Patients with pericarditis were managed by the rheumatology department. Medical files were reviewed in detail.^1–3

Results Twenty consecutive SLE patients (85% female) with a median age of 42 (IQR 32–58) years were included, out of which 15 (75%) underwent adenosine stress CMR. SLE characteristics and traditional cardiovascular risk factors are reported in tables 1 and 2. Chest pain was characterized as pleuritic in 50%, non-angina-non-pleuritic in 25%, angina like in 15% and chest pain equivalent (dyspnea precipitated by exercise suggestive of coronary involvement) in 10%. Treatable heart disease was found in 40% of patients through CMR, including CMD (27%), CAD (20%) and/or pericarditis (15%). Note that more than one cardiac disease was found in some patients. Referral for stress CMR changed medical management in 35% of patients.

Conclusion CMR demonstrated treatable heart diseases in 40% of investigated SLE patients; most commonly CMD and CAD. These results are important, since many of these patients would likely have been misdiagnosed as pleuro-pericarditis based only on the clinical picture. Thus, CMR merits further use in SLE, to correctly diagnose and treat chest symptoms. Larger studies are needed to confirm our results.

References

1. Vitali C, Bombardieri S, Jonsson R, et al. Classification criteria for Sjögren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Annals of the Rheumatic Diseases. 2002;61(6):554–8.

2. Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). Journal of Thrombosis and Haemostasis: JTH. 2006;4(2):295–306.

3. Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC). European Heart Journal. 2021;42(34):3227–337.