Early signs of cardiac impairment detected in patients with new-onset SLE
medwireNews: Patients with newly diagnosed systemic lupus erythematosus (SLE) may experience changes to the cardiac extracellular matrix that are indicative of subclinical cardiac impairment, researchers report.
“Cardiac involvement [is] the leading cause of death in patients with systemic lupus erythematosus,” Jun Pu (Shanghai Jiaotong University, China) and study co-authors write in Arthritis & Rheumatology.
And Pu said in a press release that “[o]ur findings may affect current lupus diagnostics and treatment–meaning more patients with silent cardiac insults could be identified and receive proper treatment.”
The study authors found that average native myocardial T1 values and extracellular volume (ECV) – both extracellular matrix indices measured by cardiac imaging – were significantly elevated among 50 treatment-naïve patients with newly diagnosed SLE and no chest discomfort compared with 50 healthy controls, at 1369 versus 1092 ms and 32% versus 24%, respectively.
Moreover, 12% of new-onset SLE patients had regional fibrosis as indicated by late gadolinium enhancement (LGE) positivity, but they did not have any cardiac structural abnormalities.
The investigators note that elevations in myocardial T1 and ECV, as well as the proportion of patients with regional fibrosis, were comparable among the 28 new-onset SLE patients with active disease and the 22 with non-active SLE, indicating “that drug-naïve new onset SLE [is] likely to involve silent cardiac impairment, even in inactive sub-groups.”
Pu and colleagues also analyzed cardiac parameters in 60 patients with longstanding SLE (average disease duration of 7.6 years), finding that myocardial T1 and ECV elevations were comparable in these patients and those with new-onset SLE.
However, a significantly higher proportion of patients with longstanding versus new-onset disease were LGE positive (40 vs 12%). Right ventricular (RV) volumetric enlargement and a reduction in RV ejection fraction were also observed among patients with longstanding disease, but not in those with new-onset SLE.
These findings indicate that “[t]he structural and functional changes in the myocardium were related to the SLE stage,” underscoring “the value of the early detection of myocardial involvement,” write the researchers.
“Native myocardial T1 values and ECV, rather than current clinical rheumatic and cardiac indices, could serve as early detection markers of myocardial injury before the presence of visual fibrosis and functional decompensation,” they suggest.
And the team concludes: “Further studies with larger sample sizes would be useful for evaluating the prognosis of this early detection.”
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