Reduced Left Ventricular Function on Cardiac MRI in SLE Patients Correlates with Measures of SLE Disease Activity and Inflammation

Abstract

Background: Women with SLE have an elevated risk of CVD morbidity and mortality and frequently report chest pain in the absence of obstructive CAD. Echocardiographic studies often demonstrate reduced LV function, correlating with higher disease activity. We used cardiac MRI (cMRI) to investigate the relationship between SLE, related inflammatory biomarkers and cardiac function in female SLE patients.

Methods: Women with SLE reporting chest pain with no obstructive CAD (n=13) and reference controls (n=22) were evaluated using stress-rest cMRI to measure LV structure, function, tissue characteristics, and myocardial perfusion reserve index (MPRI). Coronary microvascular dysfunction (CMD) was defined as MPRI <1.84. Serum samples were analyzed for inflammatory markers. Relationships between clinical and cMRI values of SLE subjects were assessed, and groups were compared.

Results: 40% of SLE subjects had MPRI < 1.84 on cMRI. Compared to controls, SLE subjects had higher LV volumes and mass and lower LV systolic function. SLICC DI was related to worse cardiac function and higher T1. CRP was related to higher cardiac output and a trend to better systolic function, while ESR and fasting insulin were related to lower LV mass. Lower fasting insulin levels correlated with increased ECV.

Conclusions: Among our female SLE cohort, 40% had CMD, and SLICC DI correlated with worse cardiac function and diffuse fibrosis. Higher inflammatory markers and low insulin levels may associate with LV dysfunction. Our findings underline the potential of non-invasive cMRI as a tool for monitoring cardiovascular function in SLE patients.

Keywords: Coronary Microvascular Dysfunction; Myocardial Perfusion Reserve Index; Systemic lupus Erythematosus.

Figure 1:

Comparison of cardiac structure and function in SLE patients with CMD or no CMD compared to reference controls. Statistical analysis was performed using One-Way ANOVA and Tukey’s multiple comparison test. ****p<0.0001, ***p<0.001, **p<0.01, *p<0.05, ns = not significant. LVEDVi: left ventricular end-diastolic volume index; LVESVi: left ventricular end-systolic volume index; LVSVi: left ventricular systolic volume index; LVMi: left ventricular mass index; EF: ejection fraction; CI: cardiac index

Figure 2:

Patients without CMD (no CMD) show a stronger contribution to differences in cardiac structure and function between healthy controls and SLE patients. Patients with no CMD (blue) on MPRI show a stronger contribution to overall effect of SLE on cardiac function than do patients with CMD (black bars) when compared with reference controls. Data is represented as Cohen’s d + C.I. CI: cardiac index; LVSVi: left ventricular systolic volume index; LVESVi: left ventricular end-systolic volume index; LVEDVi: left ventricular end-diastolic volume index; LVMi: left ventricular mass index; EF: ejection fraction.