A contemporary case series of lupus myocarditis

G. M. Zawadowski, K. W. Klarich, K. G. Moder, W. D. Edwards, L. T. Cooper

Research output: Contribution to journalArticle

30 Scopus citations

Abstract

Objectives: The purpose of this study was to describe clinical phenotype and treatment outcomes in lupus myocarditis (LM), an uncommon but serious manifestation of systemic lupus erythematosus (SLE). Methods: The study involved a 10-year retrospective case series of hospitalized patients with LM, with a search of a diagnosis database using systemic lupus erythematosus and either myocarditis, cardiomyopathy, or congestive heart failure, and of a pathology database for biopsy-proved LM. Results: Twenty-four patients met the study criteria, with 79% female and 82% white (age: mean (SD), 47.6 (20.4) years; follow-up: mean (SD), 9.2 (6.1) months). The frequency of antibodies SS-A (69%) and anti-RNP (62%) was greater than in published lupus populations (25%-40%). On echocardiography, the mean initial left ventricular ejection fraction was 33.8%, improving to 49.5% after a mean of 7.2 months. All patients received immunosuppression, most with high-dose corticosteroid treatment and subsequent corticosteroid taper. One patient died of cardiogenic shock during hospitalization; two patients died within one year posthospitalization. Conclusions: A high index of suspicion is necessary in suspected LM. Higher frequency of elevated SS-A and anti-RNP antibody levels in our series than in the literature is suggestive of an LM association. Echocardiography is a useful initial investigation for LM, but patients should be referred early for cardiac magnetic resonance imaging or endomyocardial biopsy to confirm diagnosis if it is clinically indicated in difficult cases.

Original languageEnglish (US)
Pages (from-to)1378-1384
Number of pages7
JournalLupus
Volume21
Issue number13
DOIs
StatePublished - Nov 1 2012

Keywords

  • Cardiac magnetic resonance
  • congestive heart failure
  • endomyocardial biopsy
  • myocarditis
  • systemic lupus erythematosus

ASJC Scopus subject areas

  • Rheumatology

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    Zawadowski, G. M., Klarich, K. W., Moder, K. G., Edwards, W. D., & Cooper, L. T. (2012). A contemporary case series of lupus myocarditis. Lupus, 21(13), 1378-1384. https://doi.org/10.1177/0961203312456752