@article{3123511,
    title = "Cardiovascular magnetic resonance detects silent heart disease missed by echocardiography in systemic lupus erythematosus",
    author = "Mavrogeni, S. and Koutsogeorgopoulou, L. and Markousis-Mavrogenis, G. and Bounas, A. and Tektonidou, M. and Lliossis, S.N.C. and Daoussis, D. and Plastiras, S. and Karabela, G. and Stavropoulos, E. and Katsifis, G. and Vartela, V. and Kolovou, G.",
    journal = "Lupus Science and Medicine",
    year = "2018",
    volume = "27",
    number = "4",
    pages = "564-571",
    publisher = "SAGE Publications Ltd",
    doi = "10.1177/0961203317731533",
    keywords = "adult;  antihypertensive therapy;  antiphospholipid syndrome;  Article;  cardiac imaging;  cardiac patient;  cardiovascular magnetic resonance;  cerebrovascular accident;  contrast enhancement;  diagnostic accuracy;  dyspnea;  echocardiography;  fatigue;  female;  heart ejection fraction;  heart repolarization;  human;  image analysis;  lung embolism;  major clinical study;  male;  medical history;  myocarditis;  priority journal;  silent myocardial infarction;  sinus tachycardia;  systemic lupus erythematosus;  tissue characterization;  venous thromboembolism;  asymptomatic disease;  cardiac muscle;  cardiomyopathy;  cine magnetic resonance imaging;  complication;  diagnostic imaging;  fibrosis;  heart infarction;  heart left ventricle function;  heart right ventricle function;  heart ventricle remodeling;  myocarditis;  pathology;  pathophysiology;  predictive value;  systemic lupus erythematosus, contrast medium;  gadolinium pentetate, Adult;  Asymptomatic Diseases;  Cardiomyopathies;  Contrast Media;  Echocardiography;  Female;  Fibrosis;  Gadolinium DTPA;  Humans;  Lupus Erythematosus, Systemic;  Magnetic Resonance Imaging, Cine;  Male;  Myocardial Infarction;  Myocarditis;  Myocardium;  Predictive Value of Tests;  Ventricular Function, Left;  Ventricular Function, Right;  Ventricular Remodeling",
    abstract = "Background: Accurate diagnosis of cardiovascular involvement in systemic lupus erythematosus (SLE) remains challenging, due to limitations of echocardiography. We hypothesized that cardiovascular magnetic resonance can detect cardiac lesions missed by echocardiography in SLE patients with atypical symptoms. Aim: To use cardiovascular magnetic resonance in SLE patients with atypical symptoms and investigate the possibility of silent heart disease, missed by echocardiography. Patients/methods: From 2005 to 2015, 80 SLE patients with atypical cardiac symptoms/signs (fatigue, mild shortness of breath, early repolarization and sinus tachycardia) aged 37 ± 6 years (72 women/8 men), with normal echocardiography, were evaluated using a 1.5 T system. Left and right ventricular ejection fractions, T2 ratio (oedema imaging) and late gadolinium enhancement (fibrosis imaging) were assessed. Acute and chronic lesions were defined as late gadolinium enhancement-positive plus T2>2 and T2<2, respectively. Lesions were characterized according to late gadolinium enhancement patterns as: diffuse subendocardial, subepicardial and subendocardial/transmural, due to vasculitis, myocarditis and myocardial infarction, respectively. Results: Abnormal cardiovascular magnetic resonance findings were identified in 22/80 (27.5%) of SLE patients with normal echocardiography, including 4/22 with recent silent myocarditis, 5/22 with past myocarditis (subepicardial scar in inferolateral wall), 9/22 with past myocardial infarction (six inferior and three anterior subendocardial infarction) and 4/22 with diffuse subendocardial fibrosis due to vasculitis. No correlation between cardiovascular magnetic resonance findings and inflammatory indices was identified. Conclusions: Cardiovascular magnetic resonance in SLE patients with atypical cardiac symptoms/signs and normal echocardiography can assess occult cardiac lesions including myocarditis, myocardial infarction and vasculitis that may influence both rheumatic and cardiac treatment. © 2017, © The Author(s) 2017."
}