Lupus myocarditis: a distinct surgical challenge in autoimmune pancarditis
A retrospective cohort study has defined the severe clinical and imaging profile of lupus myocarditis (LM), a rare but critical complication of systemic lupus erythematosus. Comparing 32 LM patients to matched controls with active SLE without myocarditis and non-autoimmune acute myocarditis, researchers found LM presents with significantly higher rates of cardiogenic shock, ICU admission, and invasive mechanical ventilation. Cardiac imaging revealed LM is uniquely characterized by pancarditis—simultaneous inflammation of the myocardium, pericardium, and valves—along with distinctive features like widespread wall motion abnormalities, reduced left ventricular ejection fraction, and late gadolinium enhancement on cardiac MRI. While two-year mortality was comparable to other myocarditis groups, the need for aggressive critical care support underscores the acuity of this condition.
Why it might matter to you: For surgeons managing complex cardiothoracic or transplant cases, this research highlights a patient population at high risk for perioperative complications. The distinct pancarditis phenotype necessitates meticulous preoperative assessment, including advanced cardiac imaging, to evaluate myocardial and valvular reserve. Understanding these unique features can inform collaborative decision-making with rheumatology and cardiology teams, potentially altering surgical timing, intraoperative monitoring strategies, and postoperative critical care pathways for patients with autoimmune diseases.
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