Zhi Yang, Zhang Tian-Yue, Zhu Yong, Zou Hao, You Yi, Wen Miao, Wang Zhong, Gao Liang-Chao, Bing Fu, Pan Shu-Yue
Department of Radiology, Chengdu Fifth People's Hospital, Chengdu, China.
Department of Rheumatology and Immunology, Chengdu Fifth People's Hospital, Chengdu, China.
Front Immunol. 2024 Nov 25;15:1504624. doi: 10.3389/fimmu.2024.1504624. eCollection 2024.
Pleural effusion (PE) is a common pulmonary manifestation in patients with systemic lupus erythematosus (SLE), and is associated with disease activity. However, little is known regarding the additive effects of PE on cardiac function. Therefore, this study aimed to investigate multi-parameter cardiovascular magnetic resonance imaging (CMR) findings in SLE patients with PE and to explore whether cardiac involvement is associated with PE.
Patients with SLE and age-matched/sex-matched healthy controls were included in this study. Patients with SLE were diagnosed according to the 2019 European League Against Rheumatism/American College of Rheumatology classification criteria. Moreover, the PE diagnosis was based on computed tomography, and the height of the effusion was > 5 mm. All enrolled individuals underwent CMR imaging, including cine and late gadolinium enhancement (LGE), T1, and T2 mapping imaging. The left and right ventricular function, LGE, T1, extracellular volume (ECV), and T2 values were evaluated.
A total of 111 patients with SLE were enrolled, of whom 26 (23.42%) had PE. White cell count, hemoglobin, CRP, ESR, and lactate dehydrogenase levels were higher in SLE patients with PE than in SLE patients without PE (P<0.05). LGE was more prevalent in SLE patients with PE compared with those without PE (P<0.001). In addition, Native T1 (1348 ± 65 ms vs. 1284 ± 67 ms vs. 1261 ± 41 ms; P<0.001), ECV (31.92 ± 4.16% vs. 28.61 ± 3.60% vs. 26.54 ± 2.94%; P<0.001), and T2 (44.76 ± 3.68 ms vs. 41.96 ± 3.62 ms vs. 39.21 ± 2.85 ms; P<0.001) values were high in SLE patients with PE, intermediate in SLE patients without PE, and the lowest in the control group. Linear regression analysis demonstrated that PE was independently associated with LGE (β=0.329; P<0.05), T1 (β=0.346; P<0.05), ECV (β=0.353; P<0.05), and T2 (β=0.201; P<0.05).
SLE patients with PE have a higher prevalence of LGE and more diffuse myocardial fibrosis and edema than SLE patients without PE. Moreover, PE is associated with increased diffuse interstitial fibrosis and edema.
胸腔积液（PE）是系统性红斑狼疮（SLE）患者常见的肺部表现，且与疾病活动相关。然而，关于PE对心功能的附加影响知之甚少。因此，本研究旨在调查合并PE的SLE患者的多参数心血管磁共振成像（CMR）表现，并探讨心脏受累是否与PE相关。
本研究纳入了SLE患者以及年龄和性别匹配的健康对照。SLE患者根据2019年欧洲抗风湿病联盟/美国风湿病学会分类标准进行诊断。此外，PE的诊断基于计算机断层扫描，且积液高度>5mm。所有纳入个体均接受了CMR成像，包括电影成像和延迟钆增强（LGE）、T1和T2mapping成像。评估了左、右心室功能、LGE、T1、细胞外容积（ECV）和T2值。
共纳入111例SLE患者，其中26例（23.42%）有PE。合并PE的SLE患者的白细胞计数、血红蛋白、C反应蛋白、红细胞沉降率和乳酸脱氢酶水平高于无PE的SLE患者（P<0.05）。与无PE的SLE患者相比，合并PE的SLE患者LGE更常见（P<0.001）。此外，合并PE的SLE患者的固有T1（1348±65ms对1284±67ms对1261±41ms；P<0.001）、ECV（31.92±4.16%对28.61±3.60%对26.54±2.94%；P<0.001）和T2（44.76±3.68ms对41.96±3.62ms对39.21±2.85ms；P<0.001）值较高，无PE的SLE患者居中，对照组最低。线性回归分析表明，PE与LGE（β = 0.329；P<0.05）、T1（β = 0.346；P<0.05）、ECV（β = 0.353；P<0.05）和T2（β = 0.201；P<0.05）独立相关。
与无PE的SLE患者相比，合并PE的SLE患者LGE患病率更高，心肌纤维化和水肿更弥漫。此外，PE与弥漫性间质纤维化和水肿增加相关。
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