Lupus myocarditis (LM) is a potentially fatal manifestation of systemic lupus erythematosus (SLE), occurring in 5–10% of patients. Clinical manifestations may vary from an unexplained tachycardia to fulminant congestive cardiac failure (CCF). With no single clinical or imaging modality being diagnostic, a rational and practical approach to the patient presenting with possible LM is essential. Markers of myocyte injury (including troponin-I and creatine kinase) may be unelevated and do not exclude a diagnosis of LM. Findings on electrocardiogram are non-specific but remain essential to exclude other causes of CCF such as an acute coronary syndrome or conduction disorders. Echocardiographic modalities including wall motion abnormalities and speckle tracking echocardiography may demonstrate regional and/or global left ventricular dysfunction and is more sensitive than conventional echocardiography, especially early in the course of LM. Cardiac magnetic resonance imaging (CMR) is regarded as the non-invasive diagnostic modality of choice in myocarditis. Whilst more sensitive and specific than echocardiography, CMR has certain limitations in the context of SLE including technical challenges in acutely unwell and uncooperative patients, contra-indications to gadolinium use in the context of renal impairment (including lupus nephritis) and limited literature regarding the application of recommended diagnostic CMR criteria in SLE. Both echocardiography as well as CMR may detect subclinical myocardial dysfunction and/or injury of which the clinical significance remains uncertain. Considering these challenges, a combined decision-making approach by rheumatologist and cardiologist, interpreting diagnostic test results within the clinical context of the patient is essential to ensure an accurate, early diagnosis of LM.

中文翻译：

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狼疮性心肌炎：回顾当前的诊断方式及其在临床实践中的应用

狼疮心肌炎 (LM) 是系统性红斑狼疮 (SLE) 的潜在致命表现，发生在 5-10% 的患者中。临床表现可能从不明原因的心动过速到暴发性充血性心力衰竭 (CCF)。由于没有单一的临床或影像学方法可以诊断，因此对可能患有 LM 的患者采取合理和实用的方法是必不可少的。肌细胞损伤标志物（包括肌钙蛋白 I 和肌酸激酶）可能未升高，不能排除 LM 的诊断。心电图的结果是非特异性的，但对于排除 CCF 的其他原因（如急性冠状动脉综合征或传导障碍）仍然至关重要。包括室壁运动异常和斑点追踪超声心动图在内的超声心动图检查可显示局部和/或整体左心室功能障碍，并且比常规超声心动图更敏感，尤其是在 LM 病程的早期。心脏磁共振成像 (CMR) 被认为是心肌炎的首选非侵入性诊断方式。虽然 CMR 比超声心动图更敏感、更特异，但在 SLE 的情况下有一定的局限性，包括急性不适和不合作患者的技术挑战、肾功能不全（包括狼疮性肾炎）情况下使用钆的禁忌症以及有关应用的文献有限推荐的 SLE 诊断 CMR 标准。超声心动图和 CMR 都可以检测出临床意义仍不确定的亚临床心肌功能障碍和/或损伤。考虑到这些挑战，风湿病学家和心脏病学家采用联合决策方法，在患者的临床背景下解释诊断测试结果对于确保 LM 的准确、早期诊断至关重要。