CMR Improves Diagnosis of Cardiac Involvement in Lupus

Cardiac magnetic resonance (CMR) can be used to diagnose systemic lupus erythematosus (SLE) ahead of clinical symptoms, according to a new study.

Researchers at Goethe University Hospital (KGU; Frankfurt am Main, Germany), University Hospital Tübingen (Germany), and other institutions conducted a study in 92 consecutive patients with SLE who were free of cardiac symptoms, and undergoing screening for cardiac involvement; study participants were age and gender-matched to 78 non-SLE controls. The aim of the study was to evaluate associations between high-sensitive troponin T (hs-TropT), a marker of myocardial injury, and cardiovascular involvement using CMR with a 3T magnetic resonance imaging (MRI) scanner.

The results showed that in SLE patients, hs-TropT was significantly and independently associated with higher native T1 and T2 MRI values, aortic and ventricular stiffness, and reduced global longitudinal strain. No relationships were found between hs-TropT and age, gender, cardiovascular risk factors, duration of systemic disease, cardiac structure or function, or late gadolinium enhancement. According to the researchers, the new CMR diagnostic method can accurately detect SLE disease presence, stage, and severity. The study was published on August 4, 2018, in Annals of the Rheumatic Diseases.

“Patients with SLE have a high prevalence of subclinical myocardial injury as demonstrated by raised high-sensitive troponin levels. CMR with T2 mapping reveals myocardial edema as the strongest predictor of hs-TropT release, underscoring the inflammatory interstitial remodeling as the main mechanism of injury,” concluded lead author Valentina Puntmann, MD, PhD, of KGU, and colleagues. “Patients without active myocardial inflammation demonstrate diffuse interstitial remodeling and increased vascular stiffness. These findings substantiate the role of CMR in screening of subclinical cardiac involvement.”

SLE is an incurable systemic autoimmune disease that can affect any part of the body, but most often harms the heart, joints, skin, lungs, blood vessels, liver, kidneys, and nervous system. SLE occurs nine times more often in women than in men, is also more common in those of non-European descent. The disease is unpredictable, with periods of illness (called flares) alternating with remissions. Treatment involves preventing flares and reducing their severity and duration using corticosteroids and anti-malarial drugs.

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