Cardiovascular magnetic resonance evaluation of paediatric patients with systemic lupus erythematosus and cardiac symptoms

• Published in: Lupus Vol. 25; no. 3; pp. 289 - 295
• Main Authors: Mavrogeni, S, Smerla, R, Grigoriadou, G, Servos, G, Koutsogeorgopoulou, L, Karabela, G, Stavropoulos, E, Spiliotis, G, Kolovou, G, Papadopoulos, G
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.03.2016; Sage Publications Ltd
• Subjects: Adult; Age Factors; Child; Contrast Media; Endocarditis - diagnostic imaging; Endocarditis - etiology; Female; Fibrosis; Gadolinium DTPA; Greece; Humans; Incidence; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - diagnosis; Magnetic Resonance Imaging, Cine; Male; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - etiology; Myocardial Infarction - physiopathology; Myocarditis - diagnostic imaging; Myocarditis - etiology; Myocarditis - physiopathology; Myocardium - pathology; Predictive Value of Tests; Risk Factors; Stroke Volume; Ventricular Function, Left; coronary artery disease; Systemic lupus erythematosus; Libman–Sacks endocarditis; cardiovascular magnetic resonance; myocarditis; diffuse subendocardial vasculitis
• ISSN: 0961-2033; 1477-0962
• DOI: 10.1177/0961203315611496

Objectives To evaluate the cardiovascular magnetic resonance (CMR) findings in a paediatric population with systemic lupus erythematosus (SLE) and cardiac symptoms. Methods Twenty-five SLE children, aged 10.2 ± 2.6 years, with cardiac symptoms and normal routine non-invasive evaluation were examined by CMR, using a 1.5 T system and compared with sex–matched SLE adults. Left ventricular (LV) volumes, ejection fraction, T2 ratio, early (EGE) and late (LGE) gadolinium enhancement were assessed. Acute and chronic lesions were characterised as LGE-positive plus T2 > 2, EGE > 4 or T2 < 2, EGE < 4, respectively. According to LGE, lesions were characterized as: (a) diffuse subendocardial, (b) subepicardial and (c) subendocardial/transmural, due to vasculitis, myocarditis and myocardial infarction, respectively. Results LV ejection fraction (LVEF) was normal in all SLEs. T2 > 2, EGE > 4 and positive epicardial LGE wall was identified in 5/25 children. Diffuse subendocardial fibrosis was documented in 1/25. No evidence of myocardial infarction was identified in any children. In contrast, in SLE adults, LGE indicative of myocardial infarction was identified in 6/25, myocarditis in 3/25, Libman–Sacks endocarditis in 1/25 and diffuse subendocardial fibrosis in 2/25. The incidence of heart disease in SLE children was lower compared to SLE adults (p < 0.05), with a predominance of myocarditis in children and myocardial infarction in adults. A significant correlation was documented between disease duration and CMR lesions (p < 0.05). Conclusion CMR identifies a predominance of myocarditis in paediatric SLE with cardiac symptoms and normal routine non-invasive evaluation. However, the incidence of cardiac lesions is lower compared to SLE adults, probably due to shorter disease duration. Significance and Innovation: CMR identifies heart involvement in a significant percentage of SLE children with cardiac symptoms and normal routine noninvasive evaluation. The incidence of heart disease is lower in SLE children compared with SLE adults. Predominance of myocarditis and myocardial infarction is observed in SLE children and SLE adults, respectively.