BACKGROUND: Increased systemic inflammation has been linked to myocardial 
dysfunction and heart failure in patients with systemic lupus erythematosus 
(SLE). Accurate detection of early myocardial changes may be able to guide 
preventive intervention. We investigated whether multiparametric imaging by 
cardiovascular magnetic resonance can detect differences between controls and 
asymptomatic SLE patients.
METHODS AND RESULTS: A total of 33 SLE predominantly female patients (mean age, 
40±9 years) underwent cardiovascular magnetic resonance for routine assessment 
of myocardial perfusion, function, and late gadolinium enhancement. T1 mapping 
was performed in single short-axis slice before and after 15 minutes of 
gadolinium administration. Twenty-one subjects with a low pretest probability 
and normal cardiovascular magnetic resonance served as a control group. Both 
groups had similar left ventricular volumes and mass and normal global systolic 
function. SLE patients had significantly reduced longitudinal strain (controls 
versus SLE, -20±2% versus -17±3%; P<0.01) and showed intramyocardial and 
pericardial late gadolinium enhancement. SLE patients had significantly 
increased native myocardial T1 (1056±27 versus 1152±46 milliseconds; P<0.001) 
and extracellular volume fraction (26±5% versus 30±6%; P=0.007) and reduced 
postcontrast myocardial T1 (454±53 versus 411±62 milliseconds; P=0.01). 
T1-derived indices were associated with longitudinal strain (r=0.37-0.47) but 
not with the presence of late gadolinium enhancement. Native myocardial T1 
values showed the greatest concordance with the presence of clinical diagnosis 
of SLE.
CONCLUSIONS: In patients with SLE and free of cardiac symptoms, there is 
evidence of subclinical perimyocardial impairment. We further demonstrate that 
T1 mapping may have potential to detect subclinical myocardial involvement in 
patients with SLE.