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Cardiac magnetic resonance imaging abnormalities in systemic lupus erythematosus: a preliminary report

Rheumatology Division, Washington University School of Medicine and St Louis VA Medical Center, St Louis, MO, USA, Rheumatology Division, Minneapolis VA Medical center and University of Minnesota, Minneapolis, MN, USA, jasvinder.singh{at}med.va.gov

P K Woodard

Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA

V G Dávila-Román

Cardiovascular Division, Department of Medicine, the Cardiovascular Imaging and Clinical Research Core Laboratory, Washington University School of Medicine, St Louis, MO, USA

A D Waggoner

Cardiovascular Division, Department of Medicine, the Cardiovascular Imaging and Clinical Research Core Laboratory, Washington University School of Medicine, St Louis, MO, USA

F R Gutierrez

Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA

J Zheng

Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA

S A Eisen

Rheumatology Division, Washington University School of Medicine and St Louis VA Medical Center, St Louis, MO, USA

The purpose of this prospective, pilot study was to determine whether differences in myocardial T2 relaxivity can be identified among active systemic lupus erythematosus (SLE) patients with clinically suspected SLE myocarditis, other active SLE patients, inactive SLE patients and age and gender matched controls. Eleven consecutive female patients (six with active SLE and five with inactive SLE), and five age, gender and race matched healthy controls underwent imaging with echocardiography and cardiac magnetic resonance imaging (MRI). Echocardiographic measurements included left ventricular end diastolic (LVEDV) and end systolic volumes (LVESV), and mass (LVM) (all indexed to body mass); ejection fraction and cardiac output. The cardiac MRI measurement was the T2 relaxation time (an index of soft tissue signal, with higher levels suggestive of increased tissue water content). Patients with active SLE had significantly higher LVEDVand LVM than inactive SLE patients and healthy controls, and significantly larger LVESV than healthy controls. Myocardial T2 relaxation times were significantly higher in patients with active SLE compared to those with inactive SLE and to healthy controls, and remained higher even after excluding the two active SLE patients who had clinical myocarditis. The four active SLE patients who underwent repeat cardiac imaging studies after clinical improvement showed normalization of these myocardial abnormalities. The conclusion was that active SLE patients demonstrate abnormalities in myocardial structure manifested by high myocardial T2 relaxation times that normalized after clinical improvement in disease activity. These findings suggest that T2 relaxation values are a sensitive indicator of myocardial disease in patients with SLE and that myocardial T2 relaxation abnormality frequently occur in patients with active SLE, even in the absence of myocardial involvement by clinical criteria.

Key Words: cardiac imaging • MRI • myocardial abnormalities • myocarditis • SLE

Lupus, Vol. 14, No. 2, 137-144 (2005)
DOI: 10.1191/0961203305lu2050oa


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