title: Prevalence, distribution and clinical correlates of myocardial fibrosis in systemic lupus erythematosus: a cardiac magnetic resonance study.
abstract: OBJECTIVE
  To assess the prevalence, distribution and clinical correlates of myocardial fibrosis, as detected by cardiac magnetic resonance (CMR), in systemic lupus erythematosus (SLE).
  
  
  METHODS
  Forty-one subjects (average age 39 ± 12 years and 80% female) with SLE underwent CMR imaging at 1.5T, using late gadolinium enhancement (LGE) to quantify the area of myocardial fibrosis in the left ventricle (LV). Subjects also underwent transthoracic echocardiography (TTE) and exercise testing.
  
  
  RESULTS
  LGE was detected in 15/41 subjects, 11 with localized LGE (<15% LV mass) and four with extensive LGE (>15% LV mass). The commonest site of LGE was the interventricular septum, with all but one case demonstrating an intramural or inflammatory pattern. The mean age of the >15% LGE group (55 ± 15 years) was significantly higher than the <15% or absent LGE subgroups. Based on both CMR and TTE measurements, subjects with LGE > 15% demonstrated a reduced E/A ratio of 0.9 ± 0.4 relative to the <15% and absent LGE subgroups. LV end-systolic volume (ESVi), end-diastolic volume (EDVi) and maximum exercise capacity were also reduced in the >15% LGE group.
  
  
  CONCLUSIONS
  Mid-wall myocardial fibrosis occurs frequently in SLE and is strongly associated with advancing subject age, but not with SLE duration or severity. Extensive LGE may be associated with diastolic dysfunction and impaired exercise capacity, although this may be an epiphenomenon of age. Cardiac magnetic resonance with quantitative assessment of LGE may provide a basis for cardiac risk stratification in SLE.
authors.affiliation: Sydney Medical School, The University of Sydney, Sydney, Australia martin.seneviratne@sswahs.nsw.gov.au.
authors.forename: M G
authors.initials: MG
authors.lastname: Seneviratne
authors.affiliation: Sydney Medical School, The University of Sydney, Sydney, Australia Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia Heart Research Institute, Newtown, NSW, Australia.
authors.forename: S M
authors.initials: SM
authors.lastname: Grieve
authors.affiliation: Sydney Medical School, The University of Sydney, Sydney, Australia Department of Cardiology, Royal North Shore Hospital, St Leonards, NSW, Australia.
authors.forename: G A
authors.initials: GA
authors.lastname: Figtree
authors.affiliation: Sydney Medical School, The University of Sydney, Sydney, Australia Department of Clinical Immunology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Garsia
authors.affiliation: Sydney Medical School, The University of Sydney, Sydney, Australia Heart Research Institute, Newtown, NSW, Australia Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
authors.forename: D S
authors.initials: DS
authors.lastname: Celermajer
authors.affiliation: Sydney Medical School, The University of Sydney, Sydney, Australia Department of Clinical Immunology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Adelstein
authors.affiliation: Sydney Medical School, The University of Sydney, Sydney, Australia Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Puranik
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D003287:Contrast Media / Q000008:administration & dosage; D004452:Echocardiography; D017079:Exercise Tolerance; D005260:Female; D005355:Fibrosis; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds / Q000008:administration & dosage; D015995:Prevalence; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol
keywords: Systemic lupus erythematosus; cardiovascular disease; magnetic resonance imaging