Comparison of cardiac MRI features of fibrosis and strain for early cardiac dysfunction assessment in patients with systemic lupus erythematosus and Sjögren's syndrome.
Yang Z, Wang L, et al. • Lupus science & medicine • 2026
Coexisting Sjögren's syndrome was independently associated with greater subclinical left ventricular dysfunction and more pronounced myocardial tissue abnormalities in patients with systemic lupus erythematosus.
Key Findings
Results
Patients with SLE and coexisting SS had significantly worse global longitudinal strain (GLS) compared to patients with SLE alone and healthy controls.
GLS was -14.21% (-16.74, -12.81) in SLE with SS versus -16.38% (-17.73, -14.25) in SLE without SS versus -17.09% (-17.63, -12.97) in healthy controls (p=0.030)
A more negative GLS value indicates better function; thus, the least negative value in SLE-with-SS group indicates the worst longitudinal strain
Global circumferential strain and global radial strain did not differ significantly among the three groups (p>0.05)
Study included 36 patients with SLE and coexisting SS, 36 patients with SLE without SS, and 20 age- and sex-matched healthy controls
Results
Native T1 values were highest in patients with SLE and coexisting SS compared to SLE alone and healthy controls.
Native T1 values were 1302 ms (1266, 1338) in SLE with SS versus 1265 ms (1216, 1289) in SLE without SS versus 1262 ms (1241, 1314) in healthy controls (p=0.016)
Elevated native T1 values are associated with myocardial fibrosis and/or edema
The difference was statistically significant across the three groups
Results
Extracellular volume fraction (ECV) was highest in patients with SLE and coexisting SS.
ECV was 29.00% (27.00, 31.00) in SLE with SS versus 27.50% (25.25, 29.00) in SLE without SS versus 27.00% (25.00, 29.00) in healthy controls (p=0.019)
ECV is a marker of diffuse myocardial fibrosis
The difference was statistically significant across the three groups
Results
Native T2 values did not differ significantly among the three groups.
Native T2 values were similar across SLE with SS, SLE without SS, and healthy controls (p>0.05)
T2 mapping is primarily a marker of myocardial edema and inflammation
The absence of T2 differences suggests the tissue abnormalities may be more fibrotic than inflammatory in nature
Results
Late gadolinium enhancement (LGE) prevalence was not significantly different between SLE patients with and without coexisting SS.
LGE was detected in 30.56% of patients with SLE and coexisting SS and 25.00% of patients with SLE without SS
The between-group difference was not statistically significant (p=0.792)
LGE detects focal myocardial fibrosis or scarring
Results
Coexisting SS was independently associated with impaired GLS, higher native T1, and higher ECV in multivariable regression analyses among all SLE patients.
Coexisting SS was independently associated with impaired GLS (β = -0.211, p=0.041)
Coexisting SS was independently associated with higher native T1 (β = 0.227, p=0.048)
Coexisting SS was independently associated with higher ECV (β = 0.268, p=0.009)
Both univariable and multivariable linear regression analyses were performed to assess these associations
What This Means
This research suggests that when patients with lupus (systemic lupus erythematosus, or SLE) also have Sjögren's syndrome (SS) — another autoimmune disease that primarily causes dry eyes and dry mouth — their hearts show greater signs of damage than lupus patients without Sjögren's syndrome. The researchers used cardiac MRI (magnetic resonance imaging) to look at 36 lupus patients with Sjögren's, 36 lupus patients without Sjögren's, and 20 healthy volunteers. They measured how well the heart muscle stretches and squeezes, and used special imaging techniques to detect scarring and tissue changes in the heart muscle.
The study found that lupus patients who also had Sjögren's syndrome had the poorest heart muscle stretching function (measured as global longitudinal strain), as well as higher levels of two markers associated with diffuse heart muscle scarring or fibrosis (native T1 values and extracellular volume fraction). Importantly, these differences held up even after accounting for other factors, meaning the presence of Sjögren's syndrome itself appears to contribute to worse heart involvement beyond what lupus alone causes. The rate of visible focal scarring detected by contrast dye (late gadolinium enhancement) was similar between lupus patients with and without Sjögren's, suggesting the additional damage may be more subtle and diffuse rather than in discrete spots.
This research suggests that clinicians managing lupus patients who also have Sjögren's syndrome should be aware that these patients may face a higher risk of subclinical (hidden, not yet symptomatic) heart problems. Early detection using cardiac MRI could be important for monitoring this group. However, the authors note that longer-term studies are needed to understand whether these MRI findings translate into worse heart outcomes over time.
Yang Z, Wang L, Meng X, Zhu Y, Gao L, Wu L, et al.. (2026). Comparison of cardiac MRI features of fibrosis and strain for early cardiac dysfunction assessment in patients with systemic lupus erythematosus and Sjögren's syndrome.. Lupus science & medicine. https://doi.org/10.1136/lupus-2026-002066