Patient characteristics and case description
| Cardiac symptoms | ||||||
| Demographics | CVD risk factors | SLE characteristics | Laboratory data | ECG, echo and coronary evaluation (CAC or catheterisation) | Cardiac FDG PET findings | Treatment and follow -up (f/u) |
| 32-year-old male Hispanic | No symptoms Never smoker | SLE × 5 years h/o NPSLE SLEDAI-2K=1 SDI=0 ANA, SSA, SSB, DNA on HCQ | C3—87; C4—28; DNA—25; ESR—11 CRP—3.5; Trop<0.01; Pro-BNP—NA | ECG—sinus tachycardia; Echo—EF 56%; CAC—17 | Diffuse FDG myocardial uptake | Prednisone 1 mg/kg, MMF 3 g/day 6-month f/u echo: EF 60% |
| 31-year-old female Hispanic | Chest pain, palpitations Former smoker | SLE × 11 years h/o LN SLEDAI-2K=4 SDI=0 ANA, SSA, SSB, DNA on HCQ | C3—91; C4—14; DNA—9.9; ESR—7; CRP—0.4; Trop<0.01; Pro-BNP—41 | ECG—sinus tachycardia, RBBB; Echo—EF 60%; CAC—0 | Diffuse FDG myocardial uptake | Prednisone 1mg/kg, MMF 3 g/day 6-month f/u echo: EF 60% |
| 55-year-old female African American | Chest pain Former smoker, h/o lupus pericarditis | SLE × 16 years h/o LN SLEDAI-2K=9 SDI=1 ANA, DNA on HCQ | C3—71; C4—10.5; DNA—38.8; ESR—6; CRP—85; Trop<0.01; Pro-BNP—820 | ECG—sinus tachycardia, non-specific ST-T changes; Echo—EF 20%, pericardial effusion, valvular abnormalities; Catheterisation—non-obstructive CAD | Diffuse FDG myocardial uptake | Methylprednisolone 1 g/day ×3 days, then prednisone 1 mg/kg Other—Metoprolol, carvedilol, valsartan 8-month f/u echo: EF 60% |
| 67-year-old male African American | Shortness of breath Never smoker, HTN, DM | SLE × 20 years SLEDAI-2K=2 SDI=5 ANA, SSA on HCQ | C3—91; C4—26; DNA— <6.0; ESR— 596; CRP—19.6; Trop<0.01; Pro-BNP—NA | ECG—non-specific ST-T changes, RBBB; Echo—EF 30%, global hypokinesis, LV dilatation; Catheterisation—angiographically normal coronary arteries | Diffuse FDG myocardial uptake | Prednisone 1 mg/kg, MMF 3 g/day Other- carvedilol, amlodipine, valsartan, rosuvastatin, aspirin 13-month f/u cardiac FDG PET: EF 35%, diffuse FDG myocardial uptake decreased by 3 SUV units |
| 35-year-old female Hispanic | No symptoms Never smoker | SLE x 2 years SLEDAI-2K=2 SDI=0 ANA, SSA, DNA on HCQ | C3—140; C4—33; DNA—60.7; ESR—29; CRP—2.6; Trop<0.01; Pro-BNP—NA | ECG—sinus tachycardia; Echo—EF 55%; CAC—0 | Diffuse FDG myocardial uptake | Prednisone 1 mg/kg, MMF 3 g/day 5-month f/u cardiac FDG PET: No FDG uptake. EF 62% |
| 47-year-old female African American | Shortness of breath Never smoker | SLE × 17 years h/o LN SLEDAI-2K=18 SDI=2 ANA, DNA, Sm, RNP On HCQ | C3—62; C4—11; DNA—192.8; ESR—25; CRP—0.3; Trop<0.01; Pro-BNP—10235 | ECG—non-specific ST-T changes; Echo—EF 20%, global hypokinesis, left atrial enlargement; Catheterisation—angiographically normal coronary arteries | Diffuse FDG myocardial uptake | Prednisone 1 mg/kg, MMF 3 g/day. Other—carvedilol, nifedipine, aspirin, atorvastatin. Lost to follow-up |
| 37-year-old female African American | Chest pain Never smoker | SLE × 9 years h/o LN SLEDAI-2K=12 SDI=2 ANA, DNA, Sm, RNP On HCQ | C3—52; C4—0; DNA—1098.2; ESR—52; CRP—12; Trop—0.75; Pro-BNP—NA | ECG—non-specific ST-T changes; Echo—EF 40%, wall motion abnormality, pericardial effusion; Catheterisation—mid LAD 70% occlusion and 100% D1 occlusion | Diffuse FDG myocardial uptake | Prednisone 1mg/kg, Cyclophosphamide 500mg/m2 intravenous monthly Other—carvedilol, hydralazine, isosorbide mononitrate, aspirin, atorvastatin 6-month f/u echo: EF 50%, impaired LV relaxation. No wall motion abnormality |
| 42-year-old female Hispanic | Chest pain Current smoker | SLE × 7 years SLEDAI-2K=6 SDI=0 ANA, SSA, SSB, DNA, Sm On HCQ | C3—82; C4—12; DNA—130.1; ESR—77; CRP—0.6; Trop<0.01; Pro-BNP—NA | ECG—sinus tachycardia, non-specific ST-T changes; Echo—EF 50%, pericardial effusion, valvular abnormality; CAC—0 | Diffuse FDG myocardial uptake | Prednisone 1 mg/kg, MMF 3 g/day Other—metoprolol, atorvastatin 6-month f/u echo: EF 55%, impaired LV relaxation |
Reference values: DNA≤24.9 IU/mL; C3 (80–162 mg/dL); C4 (14–47 mg/dL); ESR (0–20 mm/hour); CRP (<10 mg/L); Troponin<0.01 ng/mL; pro-BNP<178 pg/mL.
ANA, antinuclear antibody; CAC, coronary artery calcium; CAD, coronary artery disease; CRP, C reactive protein; CVD, cardiovascular disease; D1, first diagonal branch. DNA, anti-ds-DNA antibody; ECG, electrocardiogram; Echo, echocardiogram; EF, ejection fraction; ESR, erythrosedimentation rate; FDG PET, fluorodeoxyglucose positron emission tomography; HCQ, hydroxychloroquine; h/o, history of; LAD, left anterior descending artery; LN, lupus nephritis; LV, left ventricle; MMF, mycophenolate mofetil; NA, not available; NPSLE, neuropsychiatric SLE; pro-BNP, pro-beta natriuretic peptide; RBBB, right bundle branch block; RNP, anti-ribonucleoprotein antibody; SDI, Systemic Lupus International Collaborating Clinics (SLICC) damage index for SLE; SLE, systemic lupus erythematosus; SLEDAI-2K, SLE Disease Activity Index 2000; Sm, anti-Smith antibody; SSA, anti-SSA antibody; SSB, anti-SSB antibody; SUV, standardised uptake values; Trop, troponin.