الفهرس 
Acknowledgement
Cardiac ImagingOnly 14 pages are availabe for public view
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Abstract
In SLE, the autoimmune process is directed against almost all organs, leading to a numerous clinical manifestations including arthritis, skin, manifestations, blood cell abnormalities, renal affection and cardiovascular manifestations e.g. valvular and pericardial involvement, myocardial dysfunction, conduction disorders, accelerated atherosclerosis and thromboembolic disease. Despite its initially asymptomatic course, cardiovascular involvement is associated with increased morbidity and mortality of SLE patients. Serious SLE-related cardiovascular events include myocardial infarctions, strokes, thromboembolic events and heart failure. Traditional risk factors for atherosclerosis, inflammatory nature of the disease, antibodies, acceleration of endothelial dysfunction, and SLE therapy all play a role in the pathogenesis of cardiovascular affection in SLE. Cardiac manifestations of SLE could be recognized by echocardiography and non- invasive tests. Echocardiographic findings that are significantly present in SLE patients including mitral, aortic and tricuspid regurgitation, pericardial effusion, left ventricular hypertrophy and left atrial dilation. CMR has emerged as a novel, less invasive tool that can detect cardiovascular complications encountered in SLE patients e.g., coronary artery disease, valvular disease, pericarditis and myocarditis. CMR (cine, based on [SSFP] technique) has become the “gold standard” for measuring ventricular volumes, LVEF and mass. Multi-parametric MRI techniques can detect subtle myocardial changes before a significant cardiac dysfunction develops. Aim of the work: Detection of subclinical cardiac involvement and its relation to disease activity. Patients and methods A cross sectional study on 36 SLE patients completing ACR 2012 classification criteria. Transthoracic echocardiography was done. Left ventricular parameters, EF, pericardial effusion, valves and pulmonary artery pressure were assessed. Multiple CMR sections were obtained from the apex to the base of the heart (T2 and T1 mapping). T1-weighted inversion recovery scout imaging 15 minutes after injection of 0.2 mmol/kg of gadolinium based contrast agent. Functional and volumetric analysis was performed to quantify ventricular volumes, functions and EF. Thirty-six patients were included (mean age 32.4±8.5 years, 97.2% female, disease duration 7.9 ±5 years and SLEDAI 9.5±7.5). By echocardiography, the most frequent cardiac presentations were tricuspid regurgitation in 15 patients (41.6%), mitral regurgitation in 13 patients (36.1%), mitral thickening in 9 patients (25%),E/A<1in 7 patients (19.4%), aortic thickening in 3patients (8.3%), pericarditis in 3 patients (8.3%), aortic regurgitation in 1 patient (2.8%) and pulmonary regurgitation in 1patient (2.8%). Abnormalities detected by CMR were mitral regurgitation in 9 patients (25%), pericarditis in 9 patients (25%), mitral thickening in 5 patients (13.9%), tricuspid regurgitation in 5 patients (13.9%), myocarditis in3 patients (8.3%), Left atrial dilatation in 1patient (2.8%), Left ventriculardilatation in 1 patient (2.8%).There was negative correlation between SLEDAI score and LVEF by CMR (r=0.004, p = 0.983), positive correlation between C 3 and C 4 levels and LVEF by CMR (r= 0.002, p= 0.992) and (r =0.136, p =0.430) respectively. There was significant negative correlation between disease duration and LVEF by CMR (r= - 0.364, p =0.029). Cutoff point ≥ 11 on SLEDAI score is considered for screening for acute cardiac affection (pericarditis and myocarditis) with sensitivity 90.00 and specificity 34.62 Cardiac complications of SLE are common. CMR can identify abnormalities not evident on echocardiography as myocarditis. CMR allows simultaneous evaluation of cardiac function, structure, inflammation, and fibrosis. SLEDAI score is useful for screening of acute cardiac complications in SLE patients.