title: Native T1 and T2 mapping by CMR in lupus myocarditis: Disease recognition and response to treatment.
abstract: BACKGROUND
  Lupus myocarditis is likely more common than recognized clinically due to non-specific symptoms and lack of reliable non-invasive diagnostic tests. We investigated the role of native T1 and T2 in recognition of active myocardial inflammatory involvement in patients with systemic lupus erythematous (SLE).
  
  
  METHODS
  76 patients with clinically suspected lupus myocarditis (14 males, age: 44±16years) underwent quantitative tissue characterization with native T1 and T2 mapping. Normotensive healthy subjects taking no medication served as controls (n=46). Follow-up CMR studies were performed in a total of 35 subjects of which 14 patients received intensified anti-inflammatory treatment, as guided by SLE disease activity.
  
  
  RESULTS
  Compared to controls SLE patients had higher inflammatory markers, LV mass, native T1 and T2 values, and reduced longitudinal strain (p<0.01). In patients with a positive troponin test (n=36; 46%), native T1 and T2 were significantly higher (p<0.01) with otherwise similar proportions of diffuse perimyocardial LGE (33%) and pericardial effusion (32%). Sixty-nine patients (83%) had an abnormal native T1, whereas 51 (71%) met diagnostic criteria for acute myocarditis. Follow-up CMRs revealed significantly greater reduction in native T1 and T2 values in patients with intensified anti-inflammatory treatment (p<0.001) with the greatest change observed within the first follow-up period and plateauing thereafter. Native T1 and T2 were significant predictors of treatment response.
  
  
  CONCLUSIONS
  Native T1 and T2 mapping support recognition of lupus myocarditis and reflect the response to anti-inflammatory treatment. Native T1 and T2 mapping may support an effective, noninvasive, radiation- and gadolinium contrast-free screening method for lupus myocarditis.
authors: Department of Cardiology, Guys and St Thomas' NHS Trust, London, United Kingdom; Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Alcalá University, Madrid, Spain; Division of Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt, Germany.
authors: Rocio
authors: R
authors: Hinojar
authors: Department of Cardiology, Guys and St Thomas' NHS Trust, London, United Kingdom.
authors: Lucy
authors: L
authors: Foote
authors: Lupus Unit, Guys and St Thomas' NHS Trust, London, United Kingdom.
authors: Shirish
authors: S
authors: Sangle
authors: Cardiovascular Division, King's College London, United Kingdom.
authors: Mike
authors: M
authors: Marber
authors: Cardiovascular Division, King's College London, United Kingdom.
authors: Manuel
authors: M
authors: Mayr
authors: Department of Cardiology, Guys and St Thomas' NHS Trust, London, United Kingdom.
authors: Gerry
authors: G
authors: Carr-White
authors: Lupus Unit, Guys and St Thomas' NHS Trust, London, United Kingdom.
authors: David
authors: D
authors: D'Cruz
authors: Department of Cardiology, Guys and St Thomas' NHS Trust, London, United Kingdom; Division of Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt, Germany.
authors: Eike
authors: E
authors: Nagel
authors: Department of Cardiology, Guys and St Thomas' NHS Trust, London, United Kingdom; Division of Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt, Germany; Department of Cardiology, Division of Internal Medicine III, Goethe University Frankfurt, Frankfurt, Germany. Electronic address: vppapers@icloud.com.
authors: Valentina O
authors: VO
authors: Puntmann
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D009205:Myocarditis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D009206:Myocardium / Q000473:pathology*; D011379:Prognosis; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents
keywords: Lupus; Mapping; Myocarditis; Native T1; T1 mapping; T2