Background
Cardiovascular disease (CVD) has become increasingly recognized as a cause of mortality, especially in patients with long-standing systemic lupus erythematosus (SLE).

Aim of the work
To detect subclinical cardiac involvement and its relation to clinical characteristics, disease activity and damage.

Patients and methods
Transthoracic echocardiography (TTE) was performed in 36 SLE patients. Cardiac magnetic resonance (CMR) sections were obtained. T1-weighted inversion recovery scout images were obtained after injection of gadolinium.

Results
Thirty-six patients were included with a mean age of 32.4 ± 8.5 years; 35 females and 1 male; with disease duration of 7.9 ± 5 years. The frequent cardiac presentations on TTE were tricuspid regurgitation (TR) (41.6%), mitral regurgitation (MR) (36.1%), mitral thickening (25%), early diastolic mitral flow/mitral flow during atrial contraction (E/A) < 1 (19.4%). The most frequent cardiac presentations by CMR were MR (25%), pericarditis (25%), mitral thickening (13.9%), TR (13.9%), myocarditis (8.3). Neither SLE Disease Activity Index (SLEDAI) nor Systemic Lupus International Collaborating Clinics (SLICC) damage index, high- sensitivity-C reactive protein (hsCRP), C3 and C4 levels were significantly correlated with the ejection fraction (EF) by CMR. There was significant negative correlation between disease duration and EF by CMR (r = −0.36, p = 0.03). Using multiple regression, EF by CMR was strongly predicted by disease duration (p = 0.025). The analysis of EF and MR fraction by CMR and TTE showed acceptable moderate agreement. CMR and TTE showed 83.3% agreement in the detection of pericarditis.

Conclusion
CMR is superior to echocardiography in detection of subclinical abnormalities in SLE.