Comparison of cardiac MRI features of fibrosis and strain for early cardiac dysfunction assessment in patients with systemic lupus erythematosus and Sjögren's syndrome.

Abstract

Objectives: The additional impact of coexisting Sjögren's syndrome (SS) on cardiac involvement in patients with systemic lupus erythematosus (SLE) remains insufficiently understood. This study aimed to investigate the association of coexisting SS with cardiac function and left ventricular (LV) remodelling in patients with SLE using cardiac magnetic resonance (CMR) imaging.

Methods: The study included 36 consecutive patients with SLE and coexisting SS, 36 patients with SLE without SS and 20 age- and sex-matched healthy controls who underwent CMR. LV global strain parameters, native T1 and T2 values, extracellular volume fraction(ECV) and late gadolinium enhancement (LGE) were compared among the three groups. Univariable and multivariable linear regression analyses were performed to investigate the associations of coexisting SS with LV global strain and myocardial mapping parameters.

Results: Patients with SLE and coexisting SS had the lowest global longitudinal strain (GLS) between the three groups (-14.21% (-16.74, -12.81) vs -16.38% (-17.73, -14.25) vs -17.09% (-17.63, -12.97), p=0.030). However, there were similar global circumferential strain and global radial strain between those three groups (p>0.05). Native T1 values were highest in patients with SLE and coexisting SS (1302 ms (1266, 1338) vs 1265 ms (1216, 1289) in patients with SLE without SS and 1262 ms (1241, 1314) in healthy controls, p=0.016). Similarly, ECV was highest in the SLE-with-SS group (29.00% (27.00, 31.00) vs 27.50% (25.25, 29.00) and 27.00% (25.00, 29.00), respectively, p=0.019). Native T2 values did not differ significantly among the three groups (p>0.05). LGE was detected in 30.56% of patients with SLE and coexisting SS and 25.00% of patients with SLE without SS, with no significant between-group difference (p=0.792). Among all patients with SLE, coexisting SS was independently associated with impaired GLS (β = -0.211, p=0.041), higher native T1 (β=0.227, p=0.048) and higher ECV (β=0.268, p=0.009).

Conclusion: Coexisting SS was independently associated with greater subclinical LV dysfunction and more pronounced myocardial tissue abnormalities in patients with SLE. These findings suggest that SS may contribute additional cardiac involvement in SLE, although prospective longitudinal studies are required to determine its clinical and prognostic significance.