Myocardial T2 mapping by cardiovascular magnetic resonance reveals subclinical myocardial inflammation in patients with systemic lupus erythematosus

Abstract

To evaluate whether T2 mapping techniques can detect myocardial edema in patients with systemic lupus erythematosus (SLE). Twenty-four patients (mean age 54 ± 9 years) with SLE and twelve controls (mean age 50 ± 7 years) underwent cardiac MRI at 1.5 T. Standard cine images were obtained. Single-slice T2 maps and non-contrast T1 maps were acquired in a mid-cavity short-axis plane. Late gadolinium enhancement (LGE) images were obtained 15 min after 0.2 mmol/kg of contrast. SLE patients had low disease activity (mean SLE disease activity index score 0.71 ± 0.8). There were no differences in LV size or function between SLE patients and controls. No subjects had LGE. T2 times were higher in SLE patients (58.2 ± 5.6 vs. 52.8 ± 4.4 ms, p = 0.009). On multivariate analysis including demographic and LV parameters, only the diagnosis of SLE was associated with T2 time (p = 0.01). T1 times trended lower in SLE patients, (981.6 ± 65.5 vs. 963.9 ± 32.5), however, differences were not significant (p = 0.3). Repeated measures were highly correlated by linear regression for both inter- and intraobserver analysis (both R = 0.95, p < 0.001). Inter- and intraobserver bias and limits of agreement were −0.4 ± 3.8 and 1.0 ± 3.3 ms, respectively. T2-mapping identifies increased myocardial T2 times in SLE patients, likely due to subclinical myocardial edema. These findings suggest that even in SLE patients with inactive disease and normal cardiac function, low grade myocardial inflammation can be detected by this novel quantitative and highly reproducible technique.