Acute lupus myocarditis: clinical features and outcome of an oriental case series
Symptomatic myocarditis in systemic lupus erythematosus (SLE) is uncommon. We describe the clinical characteristics, management and outcomes of 11 SLE patients without any atherosclerotic risk factors, who presented with acute lupus myocarditis (ALM). All patients were female, 46% Chinese with mean...
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Veröffentlicht in: | Lupus 2005, Vol.14 (10), p.827-831 |
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description | Symptomatic myocarditis in systemic lupus erythematosus (SLE) is uncommon. We describe the clinical characteristics, management and outcomes of 11 SLE patients without any atherosclerotic risk factors, who presented with acute lupus myocarditis (ALM). All patients were female, 46% Chinese with mean age of 27 < 10 years at diagnosis of SLE. ALM was one of the initial manifestations of SLE in eight (73%) patients. The median duration from onset ALM to initiation of treatment was two weeks (range: 0.3-8). All had clinical feature of left ventricle dysfunction. The most common electrocardiographic feature was nonspecific ST/T wave changes (91%). Common echocardiographic findings included segmental wall motion abnormalities (81%) and decreased left ventricular ejection fraction (81%). Median SLE disease activity index at presentation was 16 (range: 4-30). All patients received high dose corticosteroids and 64% received intravenous pulse cyclophosphamide. There were two deaths (18%) from infections. The remaining nine survivors had no recurrence of ALM nor suffer any SLE-related damage (median SLICC damage score of 0), up to a median follow-up of four years (range: 2.5-10.1). Repeat echocardiography after six months or later showed normal LVEF in eight patients (89%). Early immunosuppressive therapy in ALM, with high dose corticosteroids and pulse intravenous cyclophosphamide, results in good cardiac outcome. |
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We describe the clinical characteristics, management and outcomes of 11 SLE patients without any atherosclerotic risk factors, who presented with acute lupus myocarditis (ALM). All patients were female, 46% Chinese with mean age of 27 < 10 years at diagnosis of SLE. ALM was one of the initial manifestations of SLE in eight (73%) patients. The median duration from onset ALM to initiation of treatment was two weeks (range: 0.3-8). All had clinical feature of left ventricle dysfunction. The most common electrocardiographic feature was nonspecific ST/T wave changes (91%). Common echocardiographic findings included segmental wall motion abnormalities (81%) and decreased left ventricular ejection fraction (81%). Median SLE disease activity index at presentation was 16 (range: 4-30). All patients received high dose corticosteroids and 64% received intravenous pulse cyclophosphamide. There were two deaths (18%) from infections. The remaining nine survivors had no recurrence of ALM nor suffer any SLE-related damage (median SLICC damage score of 0), up to a median follow-up of four years (range: 2.5-10.1). Repeat echocardiography after six months or later showed normal LVEF in eight patients (89%). Early immunosuppressive therapy in ALM, with high dose corticosteroids and pulse intravenous cyclophosphamide, results in good cardiac outcome.</description><identifier>ISSN: 0961-2033</identifier><identifier>EISSN: 1477-0962</identifier><identifier>DOI: 10.1191/0961203305lu2228oa</identifier><identifier>PMID: 16302678</identifier><language>eng</language><publisher>Thousand Oaks, CA: SAGE Publications</publisher><subject>Adult ; Atherosclerosis ; Cardiovascular disease ; Coronary vessels ; Cyclophosphamide - therapeutic use ; Dose-Response Relationship, Drug ; Drug Therapy, Combination ; Echocardiography ; Ejection fraction ; Female ; Glucocorticoids - therapeutic use ; Heart ; Humans ; Immunology ; Injections, Intravenous ; Lupus ; Lupus Erythematosus, Systemic - drug therapy ; Lupus Erythematosus, Systemic - pathology ; Myocarditis ; Myocarditis - drug therapy ; Myocarditis - pathology ; Patients ; Pulmonary arteries ; Retrospective Studies ; Rheumatology ; Severity of Illness Index ; Steroids ; Treatment Outcome ; Vein & artery diseases ; Ventricular Dysfunction, Left - drug therapy ; Ventricular Dysfunction, Left - pathology</subject><ispartof>Lupus, 2005, Vol.14 (10), p.827-831</ispartof><rights>2005 Arnold</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c314t-82cbb179eae529f5a63d816e123303df25c374bad922dbbe862fa040922f036b3</citedby><cites>FETCH-LOGICAL-c314t-82cbb179eae529f5a63d816e123303df25c374bad922dbbe862fa040922f036b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1191/0961203305lu2228oa$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1191/0961203305lu2228oa$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,4024,21819,27923,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16302678$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Law, W G</creatorcontrib><creatorcontrib>Thong, B Y</creatorcontrib><creatorcontrib>Lian, T Y</creatorcontrib><creatorcontrib>Kong, K O</creatorcontrib><creatorcontrib>Chng, H H</creatorcontrib><title>Acute lupus myocarditis: clinical features and outcome of an oriental case series</title><title>Lupus</title><addtitle>Lupus</addtitle><description>Symptomatic myocarditis in systemic lupus erythematosus (SLE) is uncommon. We describe the clinical characteristics, management and outcomes of 11 SLE patients without any atherosclerotic risk factors, who presented with acute lupus myocarditis (ALM). All patients were female, 46% Chinese with mean age of 27 < 10 years at diagnosis of SLE. ALM was one of the initial manifestations of SLE in eight (73%) patients. The median duration from onset ALM to initiation of treatment was two weeks (range: 0.3-8). All had clinical feature of left ventricle dysfunction. The most common electrocardiographic feature was nonspecific ST/T wave changes (91%). Common echocardiographic findings included segmental wall motion abnormalities (81%) and decreased left ventricular ejection fraction (81%). Median SLE disease activity index at presentation was 16 (range: 4-30). All patients received high dose corticosteroids and 64% received intravenous pulse cyclophosphamide. There were two deaths (18%) from infections. The remaining nine survivors had no recurrence of ALM nor suffer any SLE-related damage (median SLICC damage score of 0), up to a median follow-up of four years (range: 2.5-10.1). Repeat echocardiography after six months or later showed normal LVEF in eight patients (89%). Early immunosuppressive therapy in ALM, with high dose corticosteroids and pulse intravenous cyclophosphamide, results in good cardiac outcome.</description><subject>Adult</subject><subject>Atherosclerosis</subject><subject>Cardiovascular disease</subject><subject>Coronary vessels</subject><subject>Cyclophosphamide - therapeutic use</subject><subject>Dose-Response Relationship, Drug</subject><subject>Drug Therapy, Combination</subject><subject>Echocardiography</subject><subject>Ejection fraction</subject><subject>Female</subject><subject>Glucocorticoids - therapeutic use</subject><subject>Heart</subject><subject>Humans</subject><subject>Immunology</subject><subject>Injections, Intravenous</subject><subject>Lupus</subject><subject>Lupus Erythematosus, Systemic - drug therapy</subject><subject>Lupus Erythematosus, Systemic - pathology</subject><subject>Myocarditis</subject><subject>Myocarditis - drug therapy</subject><subject>Myocarditis - pathology</subject><subject>Patients</subject><subject>Pulmonary arteries</subject><subject>Retrospective Studies</subject><subject>Rheumatology</subject><subject>Severity of Illness Index</subject><subject>Steroids</subject><subject>Treatment Outcome</subject><subject>Vein & artery diseases</subject><subject>Ventricular Dysfunction, Left - drug therapy</subject><subject>Ventricular Dysfunction, Left - pathology</subject><issn>0961-2033</issn><issn>1477-0962</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kE9LxDAQxYMo7rr6BTxI8OCtbiZp09bbsvgPFkTQc0nTiXRpmzVpDvvtzbILCwqehsf85s3MI-Qa2D1ACXNWSuBMCJZ1gXNeWHVCppDmeRI7_JRMd0CyIybkwvs1Y0xAKc_JBKRgXObFlLwvdBiRdmETPO23VivXtGPrH6ju2qHVqqMG1RgceqqGhtowatsjtSZKal2LwxgZrTxSj1H6S3JmVOfx6lBn5PPp8WP5kqzenl-Xi1WiBaRjUnBd15CXqDDjpcmUFE0BEoHHh0RjeKZFntaqKTlv6hoLyY1iKYvSMCFrMSN3e9-Ns98B_Vj1rdfYdWpAG3wFeQqiKGQEb3-BaxvcEG-rYmpSlDmICPE9pJ313qGpNq7tldtWwKpd2tXftOPQzcE51D02x5FDvBGY7wGvvvC49h_LHz60iQo</recordid><startdate>2005</startdate><enddate>2005</enddate><creator>Law, W G</creator><creator>Thong, B Y</creator><creator>Lian, T Y</creator><creator>Kong, K O</creator><creator>Chng, H H</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9-</scope><scope>K9.</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope></search><sort><creationdate>2005</creationdate><title>Acute lupus myocarditis: clinical features and outcome of an oriental case series</title><author>Law, W G ; Thong, B Y ; Lian, T Y ; Kong, K O ; Chng, H H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c314t-82cbb179eae529f5a63d816e123303df25c374bad922dbbe862fa040922f036b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Adult</topic><topic>Atherosclerosis</topic><topic>Cardiovascular disease</topic><topic>Coronary vessels</topic><topic>Cyclophosphamide - therapeutic use</topic><topic>Dose-Response Relationship, Drug</topic><topic>Drug Therapy, Combination</topic><topic>Echocardiography</topic><topic>Ejection fraction</topic><topic>Female</topic><topic>Glucocorticoids - therapeutic use</topic><topic>Heart</topic><topic>Humans</topic><topic>Immunology</topic><topic>Injections, Intravenous</topic><topic>Lupus</topic><topic>Lupus Erythematosus, Systemic - drug therapy</topic><topic>Lupus Erythematosus, Systemic - pathology</topic><topic>Myocarditis</topic><topic>Myocarditis - drug therapy</topic><topic>Myocarditis - pathology</topic><topic>Patients</topic><topic>Pulmonary arteries</topic><topic>Retrospective Studies</topic><topic>Rheumatology</topic><topic>Severity of Illness Index</topic><topic>Steroids</topic><topic>Treatment Outcome</topic><topic>Vein & artery diseases</topic><topic>Ventricular Dysfunction, Left - drug therapy</topic><topic>Ventricular Dysfunction, Left - pathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Law, W G</creatorcontrib><creatorcontrib>Thong, B Y</creatorcontrib><creatorcontrib>Lian, T Y</creatorcontrib><creatorcontrib>Kong, K O</creatorcontrib><creatorcontrib>Chng, H H</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>Lupus</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Law, W G</au><au>Thong, B Y</au><au>Lian, T Y</au><au>Kong, K O</au><au>Chng, H H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Acute lupus myocarditis: clinical features and outcome of an oriental case series</atitle><jtitle>Lupus</jtitle><addtitle>Lupus</addtitle><date>2005</date><risdate>2005</risdate><volume>14</volume><issue>10</issue><spage>827</spage><epage>831</epage><pages>827-831</pages><issn>0961-2033</issn><eissn>1477-0962</eissn><abstract>Symptomatic myocarditis in systemic lupus erythematosus (SLE) is uncommon. We describe the clinical characteristics, management and outcomes of 11 SLE patients without any atherosclerotic risk factors, who presented with acute lupus myocarditis (ALM). All patients were female, 46% Chinese with mean age of 27 < 10 years at diagnosis of SLE. ALM was one of the initial manifestations of SLE in eight (73%) patients. The median duration from onset ALM to initiation of treatment was two weeks (range: 0.3-8). All had clinical feature of left ventricle dysfunction. The most common electrocardiographic feature was nonspecific ST/T wave changes (91%). Common echocardiographic findings included segmental wall motion abnormalities (81%) and decreased left ventricular ejection fraction (81%). Median SLE disease activity index at presentation was 16 (range: 4-30). All patients received high dose corticosteroids and 64% received intravenous pulse cyclophosphamide. There were two deaths (18%) from infections. The remaining nine survivors had no recurrence of ALM nor suffer any SLE-related damage (median SLICC damage score of 0), up to a median follow-up of four years (range: 2.5-10.1). Repeat echocardiography after six months or later showed normal LVEF in eight patients (89%). Early immunosuppressive therapy in ALM, with high dose corticosteroids and pulse intravenous cyclophosphamide, results in good cardiac outcome.</abstract><cop>Thousand Oaks, CA</cop><pub>SAGE Publications</pub><pmid>16302678</pmid><doi>10.1191/0961203305lu2228oa</doi><tpages>5</tpages></addata></record> |
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subjects | Adult Atherosclerosis Cardiovascular disease Coronary vessels Cyclophosphamide - therapeutic use Dose-Response Relationship, Drug Drug Therapy, Combination Echocardiography Ejection fraction Female Glucocorticoids - therapeutic use Heart Humans Immunology Injections, Intravenous Lupus Lupus Erythematosus, Systemic - drug therapy Lupus Erythematosus, Systemic - pathology Myocarditis Myocarditis - drug therapy Myocarditis - pathology Patients Pulmonary arteries Retrospective Studies Rheumatology Severity of Illness Index Steroids Treatment Outcome Vein & artery diseases Ventricular Dysfunction, Left - drug therapy Ventricular Dysfunction, Left - pathology |
title | Acute lupus myocarditis: clinical features and outcome of an oriental case series |
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