Systemic lupus erythematosus complicated by heart failure: A case series

Abstract

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with diverse cardiovascular manifestations, among which heart failure (HF) remains underrecognized. Although diastolic dysfunction is more common, systolic dysfunction due to lupus myocarditis or medication-related cardiotoxicity can lead to significant morbidity and mortality. We describe three young female patients with SLE who developed reduced ejection fraction (EF) and global hypokinesia, likely secondary to myocarditis. Clinical presentations ranged from mild symptoms to severe decompensated HF, with variable laboratory evidence of inflammation and disease activity.

Overall, two patients had improvement in cardiac function following immunosuppressive therapy and guideline-directed HF management, while one had a progressive clinical decline and died despite treatment. These findings highlight the heterogeneity in presentation, disease activity, and outcomes of SLE-associated cardiomyopathy. Lupus myocarditis, though uncommon, should be suspected in SLE patients presenting with new-onset HF, particularly in the absence of ischemic disease. Diagnosis is typically clinical, supported by biomarkers and imaging, as endomyocardial biopsy is rarely performed. Early recognition and a multidisciplinary approach targeting both HF and underlying autoimmune activity are essential to improve outcomes.

Keywords: Systemic lupus erythematosus, heart failure, myocarditis