Reduced left ventricular function on cardiac MRI of SLE patients correlates with measures of disease activity and inflammation.

Autor:	Hagiwara AM; Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA., Montano E; Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA., Tumurkhuu G; Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA., Bose M; Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.; Kao Autoimmunity Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA., Bernardo M; Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA., Berman DS; S. Mark Taper Foundation Imaging Center, Cedars-Sinai Medical Center.; Department of Cardiology, Cedars-Sinai Medical Center., Wiens GC; Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center., Nelson MD; Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center.; Applied Physiology and Advanced Imaging Laboratory, University of Texas at Arlington, Texas, USA., Wallace D; Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.; David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, CA., Wei J; Department of Cardiology, Cedars-Sinai Medical Center.; Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center., Ishimori M; Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.; David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, CA., Merz CNB; Department of Cardiology, Cedars-Sinai Medical Center.; Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center., Jefferies C; Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.; Kao Autoimmunity Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Jazyk:	angličtina
Zdroj:	MedRxiv : the preprint server for health sciences [medRxiv] 2023 Aug 25. Date of Electronic Publication: 2023 Aug 25.
DOI:	10.1101/2023.08.24.23294127
Abstrakt:	Background: Women with SLE have an elevated risk of cardiovascular disease. Many women with SLE frequently report chest pain in the absence of obstructive coronary artery disease (CAD) due to coronary microvascular dysfunction (CMD), a form of ischemia with no obstructive CAD. Echocardiographic studies have shown that SLE patients have reduced left ventricular (LV) function, which may also correlate with higher SLE disease activity scores. As such, we used cardiac magnetic resonance imaging (cMRI) to investigate the relationship between SLE, related inflammatory biomarkers, and cardiac function in female SLE patients. Methods: We performed stress cMRI in women with SLE and chest pain with no obstructive CAD (n=13, all met ACR 1997 criteria,) and reference controls (n=22) using our published protocol. We evaluated LV function, tissue characterization (T1 mapping, ECV), and delayed enhancement, using CV142 software (Circle Cardiovascular Imaging Inc, Calgary, AB, Canada). Myocardial perfusion reserve index (MPRI) was calculated using our published protocol. SLEDAI and SLICC Damage Index (DI) were calculated per validated criteria. Serum samples were analyzed for inflammatory markers and autoantibodies. Wilcoxon rank-sum test was performed on clinical values with CMD and no CMD SLE subjects, and on cMRI values with all SLE subjects and controls. Correlation analysis was done on clinical values, and cMRI values on all SLE subjects. Results: Overall, 40% of SLE subjects had MPRI values < 1.84, consistent with CMD. Compared to controls, SLE subjects had significantly lower LVEF, and higher LVESVi and LVMi. Corresponding to this, radial, longitudinal, and circumferential strain were significantly lower in the SLE subjects. In correlation analysis of serum inflammatory biomarkers to cMRI values in the SLE subjects, SLICC DI was related to worse cardiac function (lower radial, circumferential and longitudinal strain) and higher T1 time. Additionally, fasting insulin and ESR were negatively correlated with LVMi. Fasting insulin also negatively correlated with ECV. CRP had a positive association with LVESV index and CI and a negative association with longitudinal strain. Conclusions: Among women with SLE with chest pain and no obstructive CAD, 40% have CMD. While evaluations of known inflammatory markers (such as CRP and ESR) predictably correlated with decreased cardiac function, our study found that decreased fasting insulin levels as a novel marker of diminished LV function. In addition, low insulin levels were observed to correlate with increased LVMi and ECV, suggesting a cardioprotective effect of insulin in SLE patients. We also noted that SLICC DI, an assessment of SLE damage, correlates with cardiac dysfunction in SLE. Our findings underline the potential of non-invasive cMRI as a tool for monitoring cardiovascular function in SLE, particularly in patients with high SLICC DI, ESR and CRP and low fasting insulin levels. Competing Interests: The authors have no disclosures to report.
Databáze:	MEDLINE
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