Cardiac Involvement in Systemic Lupus Erythematosus Patients: Imaging Approach

Background: Lupus myocarditis is a potentially life-threatening condition. It can be oligosymptomatic or even silent. Lupus myocarditis necessitates a reliable imaging tool for early detection. Objective: This study aimed to assess myocardial edema in active Systemic Lupus Erythematosus (SLE) patients with T2 weighted dual inversion recovery black blood sequence. Methods: Cardiac MRI was performed on 20 active SLE patients (17 females and 3 males) with no history of previous cardiovascular diseases. Transthoracic echocardiography was performed for all patients. Results: Functional MRI analysis revealed preserved EF% (n=12) and reduced EF% (n=8). A highly statistically significant correlation between EF measured by ECHO and CMR was detected. The analysis revealed an excellent agreement between the two measures, ICC=0.753. Myocardial edema was noticed in 5 patients. One case showed delayed enhancement in LGE images and 7 patients (7/20) had pericardial effusion successfully diagnosed by both echocardiography and CMR. Conclusion: T2-double IR black blood imaging identified the worthy percentage of myocardial edema in active SLE patients, even in absence of clinical symptoms, denoting early myocardial involvement. Thus, cardiac MRI is a potential non-invasive diagnostic tool for cardiac surveillance in SLE patients.