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Co-morbidities
Myocarditis in systemic lupus erythematosus diagnosed by 18F-fluorodeoxyglucose positron emission tomography
  1. Alexandra Perel-Winkler1,
  2. Sabahat Bokhari2,3,
  3. Thania Perez-Recio1,
  4. Afshin Zartoshti1,
  5. Anca Askanase1 and
  6. Laura Geraldino-Pardilla1
  1. 1 Division of Rheumatology, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York City, New York, USA
  2. 2 Division of Cardiology, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York City, New York, USA
  3. 3 Nuclear Cardiology Laboratory, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York City, New York, USA
  1. Correspondence to Dr Laura Geraldino-Pardilla; lbg2124{at}cumc.columbia.edu

Abstract

Objectives Cardiovascular diseaseand heart failure (CHF) are leading causes of death in systemic lupus erythematosus (SLE). The underlying mechanisms for increased CHF in SLE are unclear but myocardial inflammation and lupus myocarditis (LM) may play a role. We propose that 18F-fluorodeoxyglucose–positron emission tomography (18F-FDG–PET)/CT can help diagnose LM.

Methods This report describes eight patients with presumed LM; five patients were evaluated due to active cardiorespiratory symptoms and three patients were participating in a pilot study to determine the prevalence of subclinical myocarditis in SLE. Clinical characteristics, laboratory and cardiac testing including electrocardiography (ECG), transthoracic echocardiogram (TTE), coronary artery evaluation as well as 18F-FDG–PET/CT imaging are discussed.

Results Four patients were African American and the others were Hispanic. Half presented with chest pain; 37% had dyspnoea and 25% were asymptomatic. The median SLE Disease Activity Index (SLEDAI-2K) was 5 (2–18) and SLICC Damage Index (SDI) 0.5 (0–5). The median troponin level was 0.08 ng/mL (0–0.9). The most common ECG findings were non-specific ST-T wave abnormalities (n=5). Fifty per cent of the patients had a decreased ejection fraction on TTE and all patients had diffuse myocardial FDG uptake on 18F-FDG–PET/CT consistent with myocardial inflammation.

Conclusion This case series is the first to describe the use of 18F-FDG–PET/CT in the diagnosis of LM and discuss the clinical characteristics and cardiac findings of eight patients with LM supporting the role for cardiac 18F-FDG–PET/CT in its diagnosis.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/lupus-2018-000265

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    Footnotes

    • AA and LG-P are joint senior authors.

    • Contributors All authors contributed to all phases of the manuscript writing.

    • Funding Funding for this project was provided in part by the Rheumatology Research Foundation Scientist Development Award CU13-2392 (LGP).

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Columbia University.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data statement All available data can be obtained by contacting the corresponding author.