High Rate of Subclinical Myocardial Injury in Systemic Lupus Erythematosus

Study data published in the Annals of Rheumatic Diseases suggest there is a high prevalence of subclinical myocardial injury among patients with systemic lupus erythematosus (SLE), as evidenced by elevated high-sensitive troponin levels.

Researchers designed a 2-site cardiac magnetic resonance imaging study (ClinicalTrials.gov identifier: NCT02407197) to measure cardiac involvement in patients with SLE. Patients with SLE and no observed cardiac symptoms (n=92) were matched by age and gender to control patients without SLE (n=78). Venous samples from all patients were analyzed for various cardiac biomarkers, including high-sensitive troponin T, high-sensitive C reactive protein, and N-terminal pro brain natriuretic peptide. Myocardial native T1 and T2 values were also assessed as measures of myocardial tissue abnormalities.

Compared with control patients, patients with SLE had significantly elevated levels of high-sensitive troponin T, high-sensitive C reactive protein, and N-terminal pro brain natriuretic peptide (all P <.01). In addition, patients with SLE had elevated myocardial native T1 and T2 levels, higher aortic and ventricular stiffness, and reduced global longitudinal strain (all P <.01) compared with control patients. Elevated native T2 levels in patients with SLE were significantly and independently associated with increased high-sensitive troponin T levels (P <.01), suggesting that myocardial edema is predictive of high-sensitive troponin T release. High-sensitive troponin T levels were also associated with myocardial T1 levels, global longitudinal strain, aortic and ventricular stiffness, and high-sensitive C reactive protein and N-terminal pro brain natriuretic peptide levels (all P <.01). However, no associations were detected between high-sensitive troponin T levels and age, gender, cardiovascular risk factors, cardiac structure or function, SLE disease duration, or late gadolinium enhancement.

On the basis of elevated high-sensitive troponin T levels, patients with SLE had a high prevalence of subclinical myocardial injury. The strong association between native T2 and high-sensitive troponin T release support inflammatory interstitial remodeling as the primary mechanism of cardiovascular injury in SLE. These study data underscore the important role of cardiac magnetic resonance in detecting cardiac involvement among patients with SLE, such that appropriate preventative care may be administered.

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Reference

Winau L, Hinojar Baydes R, Braner A, et al. High-sensitive troponin is associated with subclinical imaging biosignature of inflammatory cardiovascular involvement in systemic lupus erythematosus [published online August 4, 2018]. Ann Rheum Dis. doi: 10.1136/annrheumdis-2018-213661