Cardiovascular Disease (CVD) in Systemic Lupus Erythematosus (SLE) and Neuropsychiatric
SLE (NPSLE) has an estimated prevalence of 50% and 40%, respectively and both constitute
major causes of death among SLE patients. In this review, a combined brain/heart Magnetic
Resonance Imaging (MRI) for SLE risk stratification has been proposed.
The pathophysiologic background of NPSLE includes microangiopathy, macroscopic infarcts and
accelerated atherosclerosis. Classic brain MRI findings demonstrate lesions suggestive of NPSLE
in 50% of the NPSLE cases, while advanced MRI indices can detect pre-clinical lesions in the majority
of them, but their clinical impact still remains unknown. Cardiac involvement in SLE includes
myo-pericarditis, valvular disease/endocarditis, Heart Failure (HF), coronary macro-microvascular
disease, vasculitis and pulmonary hypertension. Classic and advanced Cardiovascular
Magnetic Resonance (CMR) indices allow function and tissue characterization for early diagnosis
and treatment follow-up of CVD in SLE.
Although currently, there are no clinical data supporting the combined use of brain/heart MRI in
asymptomatic SLE, it may have a place in cases with clinical suspicion of brain/heart involvement,
especially in patients at high risk for CVD/stroke such as SLE with antiphospholipid syndrome
(SLE/APS), in whom concurrent cardiac and brain lesions have been identified. Furthermore, it
may be of value in SLE with multi-organ involvement, NPSLE with concurrent cardiac involvement,
and recent onset of arrhythmia and/or heart failure.