Cardiovascular magnetic resonance evaluation of paediatric patients with systemic lupus erythematosus and cardiac symptoms
Cardiovascular magnetic resonance evaluation of paediatric patients with systemic lupus erythematosus and cardiac symptoms
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DOI：
10.1177/0961203315611496
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发表时间：
2016-03-01
期刊：
影响因子：
2.6
通讯作者：
Papadopoulos, G.
中科院分区：
文献类型：
--
作者：
Mavrogeni, S.;Smerla, R.;Papadopoulos, G.
目的：评估患有系统性红斑狼疮 (SLE) 和心脏症状的儿科人群的心血管磁共振 (CMR) 结果。方法：使用 1.5 T 系统对 25 名年龄 10.2 +/- 2.6 岁、有心脏症状且常规无创评估正常的 SLE 儿童进行 CMR 检查，并与性别匹配的 SLE 成人进行比较。评估左心室（LV）体积、射血分数、T2比值、早期（EGE）和晚期（LGE）钆增强。急性和慢性病变的特征分别为 LGE 阳性加 T2 > 2、EGE > 4 或 T2 < 2、EGE < 4。根据 LGE，病变特征为：(a) 弥漫性心内膜下、(b) 心外膜下和 (c) 心内膜下/透壁，分别由血管炎、心肌炎和心肌梗塞引起。结果：所有 SLE 的左心室射血分数 (LVEF) 均正常。 5/25 儿童中发现 T2 > 2、EGE > 4 且心外膜 LGE 壁呈阳性。 1/25 记录有弥漫性心内膜下纤维化。没有在任何儿童中发现心肌梗塞的证据。相比之下，在 SLE 成人中，6/25 的人发现了指示心肌梗死的 LGE，3/25 的人发现了心肌炎，1/25 的人发现了 Libman-Sacks 心内膜炎，2/25 的人发现了弥漫性心内膜下纤维化。与 SLE 成人相比，SLE 儿童的心脏病发病率较低（p < 0.05），儿童以心肌炎为主，成人以心肌梗死为主。病程和 CMR 病变之间存在显着相关性 (p < 0.05)。结论：CMR 确定了有心脏症状且常规常规无创评估正常的 SLE 儿童以心肌炎为主。然而，与 SLE 成人相比，心脏病变的发生率较低，可能是由于病程较短。意义和创新：CMR 在有心脏症状和正常常规无创评估的 SLE 儿童中确定了很大比例的心脏受累。与 SLE 成人相比，SLE 儿童心脏病的发生率较低。在 SLE 儿童和 SLE 成人中分别观察到心肌炎和心肌梗死的优势。
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.