Systemic Lupus Erythematosus Cardiomyopathy—A Case Series Demonstrating a Reversible Form of Left Ventricular Dysfunction
Identifieur interne : 002369 ( Istex/Corpus ); précédent : 002368; suivant : 002370Systemic Lupus Erythematosus Cardiomyopathy—A Case Series Demonstrating a Reversible Form of Left Ventricular Dysfunction
Auteurs : Mariko L. Ishimori ; Megha Agarwal ; Roy Beigel ; Rita K. Ng ; Nazanin Firooz ; Michael H. Weisman ; Robert J. SiegelSource :
- Echocardiography [ 0742-2822 ] ; 2014-05.
Abstract
Objective: Myocarditis is reported to be a common postmortem finding of systemic lupus erythematosus (SLE). However, most case reports on SLE cardiomyopathy (CM) have not found evidence of myocarditis upon biopsy. Our aim was to characterize the nature, course, and reversibility of left ventricular (LV) dysfunction in patients with SLE. Methods: The records of 526 SLE patients were reviewed. Patients were included if: (1) at least 4 of 11 American College of Rheumatology criteria for SLE were met, (2) testing for erythrocyte sedimentation rate and hs‐CRP were performed during hospitalization, and (3) echocardiogram demonstrated left ventricular ejection function (LVEF) <50%. Results: We identified 14 patients meeting study criteria. Mean LVEF was 33.1 ± 9% upon presentation. The main echocardiographic pattern observed was generalized hypokinesis. Twelve patients demonstrated reversal of cardiomyopathy within 1 week, showing a mean improvement in LVEF of 21.0 ± 7%. Of these, 2 patients underwent coronary angiography demonstrating no evidence of obstructive coronary disease, and 1 underwent cardiac biopsy with no evidence of myocarditis. Four patients (29%) demonstrated improvement within 3 days. Two of the 14 patients died due to their underlying medical illness and did not have a repeat echocardiogram. Conclusion: The pattern of wall‐motion abnormalities and reversibility demonstrated in the majority of these patients with SLE suggests an etiology more consistent with stress cardiomyopathy rather than myocarditis.
Url:
DOI: 10.1111/echo.12425
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<front><div type="abstract">Objective: Myocarditis is reported to be a common postmortem finding of systemic lupus erythematosus (SLE). However, most case reports on SLE cardiomyopathy (CM) have not found evidence of myocarditis upon biopsy. Our aim was to characterize the nature, course, and reversibility of left ventricular (LV) dysfunction in patients with SLE. Methods: The records of 526 SLE patients were reviewed. Patients were included if: (1) at least 4 of 11 American College of Rheumatology criteria for SLE were met, (2) testing for erythrocyte sedimentation rate and hs‐CRP were performed during hospitalization, and (3) echocardiogram demonstrated left ventricular ejection function (LVEF) <50%. Results: We identified 14 patients meeting study criteria. Mean LVEF was 33.1 ± 9% upon presentation. The main echocardiographic pattern observed was generalized hypokinesis. Twelve patients demonstrated reversal of cardiomyopathy within 1 week, showing a mean improvement in LVEF of 21.0 ± 7%. Of these, 2 patients underwent coronary angiography demonstrating no evidence of obstructive coronary disease, and 1 underwent cardiac biopsy with no evidence of myocarditis. Four patients (29%) demonstrated improvement within 3 days. Two of the 14 patients died due to their underlying medical illness and did not have a repeat echocardiogram. Conclusion: The pattern of wall‐motion abnormalities and reversibility demonstrated in the majority of these patients with SLE suggests an etiology more consistent with stress cardiomyopathy rather than myocarditis.</div>
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<profileDesc><abstract style="main" xml:id="echo12425-abs-0001"><head>Objective</head>
<p>Myocarditis is reported to be a common postmortem finding of systemic lupus erythematosus (<hi rend="fc">SLE</hi>
). However, most case reports on <hi rend="fc">SLE</hi>
cardiomyopathy (<hi rend="fc">CM</hi>
) have not found evidence of myocarditis upon biopsy. Our aim was to characterize the nature, course, and reversibility of left ventricular (<hi rend="fc">LV</hi>
) dysfunction in patients with <hi rend="fc">SLE</hi>
.</p>
<head>Methods</head>
<p>The records of 526 <hi rend="fc">SLE</hi>
patients were reviewed. Patients were included if: (1) at least 4 of 11 American College of Rheumatology criteria for <hi rend="fc">SLE</hi>
were met, (2) testing for erythrocyte sedimentation rate and hs‐CRP were performed during hospitalization, and (3) echocardiogram demonstrated left ventricular ejection function (<hi rend="fc">LVEF</hi>
) <50%.</p>
<head>Results</head>
<p>We identified 14 patients meeting study criteria. Mean <hi rend="fc">LVEF</hi>
was 33.1 ± 9% upon presentation. The main echocardiographic pattern observed was generalized hypokinesis. Twelve patients demonstrated reversal of cardiomyopathy within 1 week, showing a mean improvement in LVEF of 21.0 ± 7%. Of these, 2 patients underwent coronary angiography demonstrating no evidence of obstructive coronary disease, and 1 underwent cardiac biopsy with no evidence of myocarditis. Four patients (29%) demonstrated improvement within 3 days. Two of the 14 patients died due to their underlying medical illness and did not have a repeat echocardiogram.</p>
<head>Conclusion</head>
<p>The pattern of wall‐motion abnormalities and reversibility demonstrated in the majority of these patients with <hi rend="fc">SLE</hi>
suggests an etiology more consistent with stress cardiomyopathy rather than myocarditis.</p>
</abstract>
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<titleGroup><title sort="ECHOCARDIOGRAPHY" type="main">Echocardiography</title>
<title type="short">Echocardiography</title>
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<publicationMeta level="part" position="50"><doi origin="wiley">10.1111/echo.2014.31.issue-5</doi>
<copyright ownership="publisher">© 2014, Wiley Periodicals, Inc.</copyright>
<numberingGroup><numbering type="journalVolume" number="31">31</numbering>
<numbering type="journalIssue">5</numbering>
</numberingGroup>
<coverDate startDate="2014-05">May 2014</coverDate>
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<publicationMeta level="unit" position="50" status="forIssue" type="article"><doi>10.1111/echo.12425</doi>
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<countGroup><count number="6" type="pageTotal"></count>
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<titleGroup><title type="articleCategory">Original Investigation</title>
<title type="tocHeading1">Original Investigations</title>
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<copyright ownership="publisher">© 2013, Wiley Periodicals, Inc.</copyright>
<eventGroup><event date="2013-06-21" type="manuscriptReceived"></event>
<event date="2013-09-03" type="manuscriptRevised"></event>
<event date="2013-09-05" type="manuscriptAccepted"></event>
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<numberingGroup><numbering type="pageFirst">563</numbering>
<numbering type="pageLast">568</numbering>
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<correspondenceTo>Address for correspondence and reprint requests: Robert J. Siegel, MD, FACC, The Heart Institute, Cedars‐Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, California 90048. Fax: 310‐423‐8571; E‐mail: <email>Robert.siegel@cshs.org</email>
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<selfCitationGroup><citation type="self" xml:id="echo12425-cit-1001">(<journalTitle>Echocardiography</journalTitle>
<pubYear year="2014">2014</pubYear>
;<vol>31</vol>
:<pageFirst>563</pageFirst>
–<pageLast>568</pageLast>
)</citation>
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<contentMeta><titleGroup><title type="main">Systemic Lupus Erythematosus Cardiomyopathy—A Case Series Demonstrating a Reversible Form of Left Ventricular Dysfunction</title>
<title type="shortAuthors">Ishimori, et al</title>
</titleGroup>
<creators><creator affiliationRef="#echo12425-aff-0001" creatorRole="author" xml:id="echo12425-cr-0001"><personName><givenNames>Mariko L.</givenNames>
<familyName>Ishimori</familyName>
<degrees>M.D.</degrees>
</personName>
</creator>
<creator affiliationRef="#echo12425-aff-0002" creatorRole="author" xml:id="echo12425-cr-0002"><personName><givenNames>Megha</givenNames>
<familyName>Agarwal</familyName>
<degrees>M.D.</degrees>
</personName>
</creator>
<creator affiliationRef="#echo12425-aff-0002" creatorRole="author" xml:id="echo12425-cr-0003"><personName><givenNames>Roy</givenNames>
<familyName>Beigel</familyName>
<degrees>M.D.</degrees>
</personName>
</creator>
<creator affiliationRef="#echo12425-aff-0002" creatorRole="author" xml:id="echo12425-cr-0004"><personName><givenNames>Rita K.</givenNames>
<familyName>Ng</familyName>
<degrees>M.D.</degrees>
</personName>
</creator>
<creator affiliationRef="#echo12425-aff-0001" creatorRole="author" xml:id="echo12425-cr-0005"><personName><givenNames>Nazanin</givenNames>
<familyName>Firooz</familyName>
<degrees>M.D.</degrees>
</personName>
</creator>
<creator affiliationRef="#echo12425-aff-0001" creatorRole="author" xml:id="echo12425-cr-0006"><personName><givenNames>Michael H.</givenNames>
<familyName>Weisman</familyName>
<degrees>M.D.</degrees>
</personName>
</creator>
<creator affiliationRef="#echo12425-aff-0002" corresponding="yes" creatorRole="author" xml:id="echo12425-cr-0007"><personName><givenNames>Robert J.</givenNames>
<familyName>Siegel</familyName>
<degrees>M.D., F.A.C.C.</degrees>
</personName>
</creator>
</creators>
<affiliationGroup><affiliation type="organization" xml:id="echo12425-aff-0001"><orgDiv>Division of Rheumatology</orgDiv>
<orgName>Cedars‐Sinai Medical Center</orgName>
<address><city>Los Angeles</city>
<postCode>California</postCode>
</address>
</affiliation>
<affiliation type="organization" xml:id="echo12425-aff-0002"><orgDiv>The Heart Institute</orgDiv>
<orgName>Cedars Sinai Medical Center</orgName>
<address><city>Los Angeles</city>
<postCode>California</postCode>
</address>
</affiliation>
</affiliationGroup>
<keywordGroup type="author"><keyword xml:id="echo12425-kwd-0001">cardiology</keyword>
<keyword xml:id="echo12425-kwd-0002">cardiomyopathy</keyword>
<keyword xml:id="echo12425-kwd-0003">echocardiography</keyword>
</keywordGroup>
<abstractGroup><abstract type="main" xml:id="echo12425-abs-0001"><section xml:id="echo12425-sec-0001"><title type="main">Objective</title>
<p>Myocarditis is reported to be a common postmortem finding of systemic lupus erythematosus (<fc>SLE</fc>
). However, most case reports on <fc>SLE</fc>
cardiomyopathy (<fc>CM</fc>
) have not found evidence of myocarditis upon biopsy. Our aim was to characterize the nature, course, and reversibility of left ventricular (<fc>LV</fc>
) dysfunction in patients with <fc>SLE</fc>
.</p>
</section>
<section xml:id="echo12425-sec-0002"><title type="main">Methods</title>
<p>The records of 526 <fc>SLE</fc>
patients were reviewed. Patients were included if: (1) at least 4 of 11 American College of Rheumatology criteria for <fc>SLE</fc>
were met, (2) testing for erythrocyte sedimentation rate and hs‐CRP were performed during hospitalization, and (3) echocardiogram demonstrated left ventricular ejection function (<fc>LVEF</fc>
) <50%.</p>
</section>
<section xml:id="echo12425-sec-0003"><title type="main">Results</title>
<p>We identified 14 patients meeting study criteria. Mean <fc>LVEF</fc>
was 33.1 ± 9% upon presentation. The main echocardiographic pattern observed was generalized hypokinesis. Twelve patients demonstrated reversal of cardiomyopathy within 1 week, showing a mean improvement in LVEF of 21.0 ± 7%. Of these, 2 patients underwent coronary angiography demonstrating no evidence of obstructive coronary disease, and 1 underwent cardiac biopsy with no evidence of myocarditis. Four patients (29%) demonstrated improvement within 3 days. Two of the 14 patients died due to their underlying medical illness and did not have a repeat echocardiogram.</p>
</section>
<section xml:id="echo12425-sec-0004"><title type="main">Conclusion</title>
<p>The pattern of wall‐motion abnormalities and reversibility demonstrated in the majority of these patients with <fc>SLE</fc>
suggests an etiology more consistent with stress cardiomyopathy rather than myocarditis.</p>
</section>
</abstract>
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<mods version="3.6"><titleInfo lang="en"><title>Systemic Lupus Erythematosus Cardiomyopathy—A Case Series Demonstrating a Reversible Form of Left Ventricular Dysfunction</title>
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<name type="personal"><namePart type="given">Mariko L.</namePart>
<namePart type="family">Ishimori</namePart>
<namePart type="termsOfAddress">M.D.</namePart>
<affiliation>Division of Rheumatology, Cedars‐Sinai Medical Center, California, Los Angeles</affiliation>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">Megha</namePart>
<namePart type="family">Agarwal</namePart>
<namePart type="termsOfAddress">M.D.</namePart>
<affiliation>The Heart Institute, Cedars Sinai Medical Center, California, Los Angeles</affiliation>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">Roy</namePart>
<namePart type="family">Beigel</namePart>
<namePart type="termsOfAddress">M.D.</namePart>
<affiliation>The Heart Institute, Cedars Sinai Medical Center, California, Los Angeles</affiliation>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">Rita K.</namePart>
<namePart type="family">Ng</namePart>
<namePart type="termsOfAddress">M.D.</namePart>
<affiliation>The Heart Institute, Cedars Sinai Medical Center, California, Los Angeles</affiliation>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">Nazanin</namePart>
<namePart type="family">Firooz</namePart>
<namePart type="termsOfAddress">M.D.</namePart>
<affiliation>Division of Rheumatology, Cedars‐Sinai Medical Center, California, Los Angeles</affiliation>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">Michael H.</namePart>
<namePart type="family">Weisman</namePart>
<namePart type="termsOfAddress">M.D.</namePart>
<affiliation>Division of Rheumatology, Cedars‐Sinai Medical Center, California, Los Angeles</affiliation>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">Robert J.</namePart>
<namePart type="family">Siegel</namePart>
<namePart type="termsOfAddress">M.D., F.A.C.C.</namePart>
<affiliation>The Heart Institute, Cedars Sinai Medical Center, California, Los Angeles</affiliation>
<affiliation>E-mail: Robert.siegel@cshs.org</affiliation>
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<abstract>Objective: Myocarditis is reported to be a common postmortem finding of systemic lupus erythematosus (SLE). However, most case reports on SLE cardiomyopathy (CM) have not found evidence of myocarditis upon biopsy. Our aim was to characterize the nature, course, and reversibility of left ventricular (LV) dysfunction in patients with SLE. Methods: The records of 526 SLE patients were reviewed. Patients were included if: (1) at least 4 of 11 American College of Rheumatology criteria for SLE were met, (2) testing for erythrocyte sedimentation rate and hs‐CRP were performed during hospitalization, and (3) echocardiogram demonstrated left ventricular ejection function (LVEF) <50%. Results: We identified 14 patients meeting study criteria. Mean LVEF was 33.1 ± 9% upon presentation. The main echocardiographic pattern observed was generalized hypokinesis. Twelve patients demonstrated reversal of cardiomyopathy within 1 week, showing a mean improvement in LVEF of 21.0 ± 7%. Of these, 2 patients underwent coronary angiography demonstrating no evidence of obstructive coronary disease, and 1 underwent cardiac biopsy with no evidence of myocarditis. Four patients (29%) demonstrated improvement within 3 days. Two of the 14 patients died due to their underlying medical illness and did not have a repeat echocardiogram. Conclusion: The pattern of wall‐motion abnormalities and reversibility demonstrated in the majority of these patients with SLE suggests an etiology more consistent with stress cardiomyopathy rather than myocarditis.</abstract>
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