TY - JOUR
TI - Cardiovascular magnetic resonance evaluation of paediatric patients with
systemic lupus erythematosus and cardiac symptoms
AU - Mavrogeni, S.
AU - Smerla, R.
AU - Grigoriadou, G.
AU - Servos, G. and
AU - Koutsogeorgopoulou, L.
AU - Karabela, G.
AU - Stavropoulos, E. and
AU - Spiliotis, G.
AU - Kolovou, G.
AU - Papadopoulos, G.
JO - Lupus Science and Medicine
PY - 2016
VL - 25
TODO - 3
SP - 289-295
PB - SAGE Publications Ltd
SN - null
TODO - 10.1177/0961203315611496
TODO - Systemic lupus erythematosus; coronary artery disease; myocarditis;
diffuse subendocardial vasculitis; Libman-Sacks endocarditis;
cardiovascular magnetic resonance
TODO - 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.
ER -