Background Exploring early warning signs of cardiac involvement in new onset lupus patients by cardiac magnetic resonance (CMR).
Methods We enrolled drug-naïve new onset patients with systemic lupus erythematosus (SLE), and enrolled longstanding SLE and healthy subjects as controls. In terms of CMR, we used T1 mapping and extracellular volume (ECV) to assess extracellular changes; and used late gadolinium enhancement (LGE) to assess regional fibrosis. All the patients received cardiac assessment, in terms of cardiac symptoms, NYHA class, electrocardiogram, echocardiography and lab tests. Lupus disease activity were scored by SELENA-SLEDAI.
Results Fifty patients with drug-naïve new onset SLE, 60 patients with longstanding SLE and 50 healthy subjects were included in three centers. All the naïve patients showed no signs of cardiac impairment according to clinic assessment. Native myocardial T1 and ECV, which are extracellular matrix indices, were elevated in the new onset group (1369±79 ms vs. 1092±57 ms in the control group for native T1; 32±5% vs. 24±3% in the control group for ECV, p<0.001 respectively). No additional T1 values or ECV elevation was detected in the longstanding SLE group. In contrast, LGE was present more in long-standing than naïve SLE patients (for LGE present, 12% vs 40%, p=0.004; and for LGE size, 0.5% vs 2.1% of left ventricle, p=0.002). Our CMR findings including T1 mapping, ECV, myocardial fibrosis index-LGE, seemed irrelevant to general lupus disease activity.
Conclusions This study first indicated that drug-naïve new onset SLE was likely to involve silent cardiac impairment, without positive findings from current clinical rheumatic and cardiac indices. The structural and functional changes in the myocardium were related to the SLE stage. Native myocardial T1 values and ECV could serve as early detection markers of myocardial injury before the presence of visual fibrosis and functional decompensation.
Funding Source(s): NNSF of China 81571535, 81771737; NBRP of China 2014CB541906
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