Silent Cardiac Impairment May Be Present in New-Onset, Drug-Naive Systemic Lupus Erythematosus

Data published in Arthritis & Rheumatology revealed signs of silent myocardial impairment in patients with drug-naive, new-onset systemic lupus erythematosus (SLE), even before any symptoms of chest discomfort.

Researchers performed clinical assessments and cardiac magnetic resonance imaging in 50 patients with new onset SLE, 60 patients with longstanding SLE, and 50 healthy control patients to explore the warning signs of cardiac impairment in patients with SLE, even in the absence of cardiac symptoms.

Results showed that an analysis of cardiac enzymes, the presence and size of regional myocardial fibrosis index-late gadolinium enhancement, statin changes, and biventricular ejection fraction failed to indicate cardiac impairment among patients with new onset SLE.

However, native myocardial T1 values were elevated among patients with new onset SLE compared with the healthy control patients (1369±79 ms vs 1092±57 ms; P <.001). In addition, extracellular volume was elevated among patients with new onset SLE compared with controls (32±5% vs 24±3%; P <.001). The investigators note that the elevation was independent of SLE activity.

“The structural and functional changes in the myocardium were related to the SLE stage; this association demonstrated the value of early detection of myocardial involvement,” the authors concluded.

“Early detection of myocardial injury before the presence of [late gadolinium enhancement] and functional decompensation using native myocardial T1 values and [extracellular volume] might enable the selection of optimal medical treatments.

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Reference

Guo Q, Wu LM, Wang Z, et al. Early detection of silent myocardial impairment in patients with new onset drug-naïve systemic lupus erythematosus — a three-center prospective study (myocardial impairment in new onset SLE) [published online August 2, 2018].  Arthritis Rheumatol. 10.1002/art.40671