TY - JOUR
T1 - Prevalence, distribution and clinical correlates of myocardial fibrosis in systemic lupus erythematosus
T2 - A cardiac magnetic resonance study
AU - Seneviratne, Martin G.
AU - Grieve, S. M.
AU - Figtree, G. A.
AU - Garsia, R.
AU - Celermajer, D. S.
AU - Adelstein, S.
AU - Puranik, Rajesh
PY - 2016
Y1 - 2016
N2 - Objectives: To assess the prevalence, distribution and clinical correlates of myocardial fibrosis, as detected by cardiac magnetic resonance (CMR), in systemic lupus erythematosus (SLE). Methods: Forty-one subjects (average age 39 ± 12 years and 80% female) with SLE underwent CMR imaging at 1.5T, using late gadolinium enhancement (LGE) to quantify the area of myocardial fibrosis in the left ventricle (LV). Subjects also underwent transthoracic echocardiography (TTE) and exercise testing. Results: LGE was detected in 15/41 subjects, 11 with localized LGE (<15% LV mass) and four with extensive LGE (>15% LV mass). The commonest site of LGE was the interventricular septum, with all but one case demonstrating an intramural or inflammatory pattern. The mean age of the >15% LGE group (55 ± 15 years) was significantly higher than the <15% or absent LGE subgroups. Based on both CMR and TTE measurements, subjects with LGE > 15% demonstrated a reduced E/A ratio of 0.9 ± 0.4 relative to the <15% and absent LGE subgroups. LV end-systolic volume (ESVi), end-diastolic volume (EDVi) and maximum exercise capacity were also reduced in the >15% LGE group. Conclusions: Mid-wall myocardial fibrosis occurs frequently in SLE and is strongly associated with advancing subject age, but not with SLE duration or severity. Extensive LGE may be associated with diastolic dysfunction and impaired exercise capacity, although this may be an epiphenomenon of age. Cardiac magnetic resonance with quantitative assessment of LGE may provide a basis for cardiac risk stratification in SLE.
AB - Objectives: To assess the prevalence, distribution and clinical correlates of myocardial fibrosis, as detected by cardiac magnetic resonance (CMR), in systemic lupus erythematosus (SLE). Methods: Forty-one subjects (average age 39 ± 12 years and 80% female) with SLE underwent CMR imaging at 1.5T, using late gadolinium enhancement (LGE) to quantify the area of myocardial fibrosis in the left ventricle (LV). Subjects also underwent transthoracic echocardiography (TTE) and exercise testing. Results: LGE was detected in 15/41 subjects, 11 with localized LGE (<15% LV mass) and four with extensive LGE (>15% LV mass). The commonest site of LGE was the interventricular septum, with all but one case demonstrating an intramural or inflammatory pattern. The mean age of the >15% LGE group (55 ± 15 years) was significantly higher than the <15% or absent LGE subgroups. Based on both CMR and TTE measurements, subjects with LGE > 15% demonstrated a reduced E/A ratio of 0.9 ± 0.4 relative to the <15% and absent LGE subgroups. LV end-systolic volume (ESVi), end-diastolic volume (EDVi) and maximum exercise capacity were also reduced in the >15% LGE group. Conclusions: Mid-wall myocardial fibrosis occurs frequently in SLE and is strongly associated with advancing subject age, but not with SLE duration or severity. Extensive LGE may be associated with diastolic dysfunction and impaired exercise capacity, although this may be an epiphenomenon of age. Cardiac magnetic resonance with quantitative assessment of LGE may provide a basis for cardiac risk stratification in SLE.
KW - cardiovascular disease
KW - magnetic resonance imaging
KW - Systemic lupus erythematosus
UR - http://www.scopus.com/inward/record.url?scp=84963593648&partnerID=8YFLogxK
U2 - 10.1177/0961203315622275
DO - 10.1177/0961203315622275
M3 - Article
C2 - 26700183
AN - SCOPUS:84963593648
VL - 25
SP - 573
EP - 581
JO - Lupus
JF - Lupus
SN - 0961-2033
IS - 6
ER -