Mavrogeni Sophie, Koutsogeorgopoulou Loukia, Dimitroulas Theodoros, Markousis-Mavrogenis George, Boki Kyriaki, Katsifis Gikas, Vartela Vasiliki, Kallenberg Cees G, Kolovou Genovefa, Kitas George
Onassis Cardiac Surgery Center, Athens, Greece.
Department of Pathophysiology, Laikon Hospital, Athens, Greece.
Curr Cardiol Rev. 2020;16(3):178-186. doi: 10.2174/1573403X15666190801122105.
Cardiovascular Disease (CVD) in Systemic Lupus Erythematosus (SLE) and Neuropsychiatric SLE (NPSLE) has an estimated prevalence of 50% and 40%, respectively and both constitute major causes of death among SLE patients. In this review, a combined brain/heart Magnetic Resonance Imaging (MRI) for SLE risk stratification has been proposed. The pathophysiologic background of NPSLE includes microangiopathy, macroscopic infarcts and accelerated atherosclerosis. Classic brain MRI findings demonstrate lesions suggestive of NPSLE in 50% of the NPSLE cases, while advanced MRI indices can detect pre-clinical lesions in the majority of them, but their clinical impact still remains unknown. Cardiac involvement in SLE includes myo-pericarditis, valvular disease/endocarditis, Heart Failure (HF), coronary macro-microvascular disease, vasculitis and pulmonary hypertension. Classic and advanced Cardiovascular Magnetic Resonance (CMR) indices allow function and tissue characterization for early diagnosis and treatment follow-up of CVD in SLE. Although currently, there are no clinical data supporting the combined use of brain/heart MRI in asymptomatic SLE, it may have a place in cases with clinical suspicion of brain/heart involvement, especially in patients at high risk for CVD/stroke such as SLE with antiphospholipid syndrome (SLE/APS), in whom concurrent cardiac and brain lesions have been identified. Furthermore, it may be of value in SLE with multi-organ involvement, NPSLE with concurrent cardiac involvement, and recent onset of arrhythmia and/or heart failure.
系统性红斑狼疮（SLE）和神经精神性狼疮（NPSLE）中心血管疾病（CVD）的估计患病率分别为50%和40%，二者均是SLE患者的主要死亡原因。在本综述中，有人提出采用脑/心联合磁共振成像（MRI）对SLE进行风险分层。NPSLE的病理生理背景包括微血管病变、宏观梗死和动脉粥样硬化加速。经典脑MRI检查结果显示，50%的NPSLE病例存在提示NPSLE的病变，而先进的MRI指标可在大多数病例中检测到临床前病变，但其临床影响仍不明确。SLE的心脏受累包括心肌心包炎、瓣膜病/心内膜炎、心力衰竭（HF）、冠状动脉大/微血管疾病、血管炎和肺动脉高压。经典和先进的心血管磁共振（CMR）指标可用于SLE中CVD的早期诊断和治疗随访的功能及组织特征分析。尽管目前尚无临床数据支持在无症状SLE中联合使用脑/心MRI，但在临床怀疑有脑/心受累的病例中，尤其是在CVD/中风高危患者（如伴有抗磷脂综合征的SLE，即SLE/APS）中，联合使用脑/心MRI可能有一定作用，在这些患者中已发现同时存在心脏和脑部病变。此外，在多器官受累的SLE、合并心脏受累的NPSLE以及近期出现心律失常和/或心力衰竭的SLE中，联合使用脑/心MRI可能也有价值。
