At the time of diagnosis, systemic lupus erythematosus (SLE) patients already show signs of heart impairment, even before any symptoms of chest discomfort, a new imaging study shows.
The findings indicate that more lupus patients could receive timely cardiac treatment, according to the researchers from China.
The study, “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),” appeared in the journal Arthritis & Rheumatology.
Cardiac impairment is common in SLE patients and may appear as myocarditis, an inflammation of the heart muscle (myocardium); cardiac tamponade, the accumulation of fluid around the heart; or cardiac decompensation, a sudden worsening in symptoms of heart failure.
Despite increasing attention, SLE-associated cardiac anomalies still lack reliable examinations. Also, studies suggested that stabilizing SLE with therapy does not reduce the incidence of cardiovascular disease.
An imaging strategy called cardiac magnetic resonance (CMR) has been increasingly regarded as the best alternative to diagnose fibrosis, or scarring, of the myocardium and myocarditis in SLE patients.
Specifically, CMR techniques known as T1 mapping and extracellular volume (ECV) emerged as reliable ways to assess changes occurring outside the cells that lead to increases in the heart’s extracellular matrix — a set of molecules that support surrounding cells — a crucial element in heart disease.
A team at Shanghai Jiao Tong University in China aimed to determine whether these new techniques may help detect early signs of heart disease before the onset of cardiac symptoms.
Their three-center study included 50 untreated patients with newly diagnosed SLE, 60 patients with longstanding SLE (to determine if cardiac involvement is related to SLE) and 50 healthy individuals.
“To our knowledge, this study was the first to recruit drug-naïve new onset SLE patients without chest discomfort to assess the cardiac status in this group using CMR technique,” the scientists wrote.
Study participants represented the full course of SLE, with mild, moderate, and severe disease.
Analyses of cardiac enzymes, myocardial fibrosis, strain changes — a common approach to evaluate the function of the heart muscle — and ejection fraction, the percentage of how much blood the ventricles pump out each time they contract, failed to show cardiac impairment in the newly diagnosed patients.
However, imaging tests with the CMR techniques revealed that structural and functional changes in the heart muscle, including signs of fibrosis and edema (swelling), were already present in these patients.
Subsequent assessments demonstrated that women and patients with longer disease duration had more heart changes, as determined with ECV. Also, the scientists found that the right ventricle rather than the left was affected, which they attribute to disease progression, rather than pulmonary hypertension.
The data further showed that the extent of the changes was related to SLE stage. “This finding indicates the value of the early detection of myocardial involvement,” the researchers wrote.
They added that unlike current clinical rheumatic and cardiac indices, these noninvasive CMR techniques could help detect markers of myocardial injury before the presence of fibrosis and functional worsening.
“Our findings may affect current lupus diagnostics and treatment — meaning more patients with silent cardiac insults could be identified and receive proper treatment,” Jun Pu, an MD and PhD, one of the team’s leaders, said in a press release.
Also, the finding of more severe alterations with fibrosis in patients with longstanding SLE suggests the importance anti-fibrotic treatment in these patients.
“Whether these treatments will improve a patient’s prognosis still needs to be evaluated by further clinical studies,” added Meng Jiang, MD, PhD, the second team leade