Left atrial (LA) function is impaired in both atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). Diagnosing HFpEF remains challenging, especially in AF patients. This study aims to evaluate whether LA stiffness (LAS) can facilitate the diagnosis of HFpEF in patients with paroxysmal atrial fibrillation (pxAF). A total of 187 pxAF patients were enrolled in the discovery cohort and underwent baseline transthoracic echocardiography (TTE). LAS was measured in all patients, and HFpEF was ascertained based on the H2FPEF score (44 high-probability of HFpEF [hp-HFpEF], 143 low-probability of HFpEF [lp-HFpEF]). The left ventricular diastolic function and LA function were significantly altered in the hp-HFpEF group compared to the lp-HFpEF group. Among all echocardiographic indices, the ratio of E/MVE’ to 3D LAEF as a surrogate of LAS showed the greatest diagnostic performance in distinguishing hp-HFpEF from lp-HFpEF in pxAF patients (AUC = 0.862, 95

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) typically manifests in the first weeks of life. We report a 28-year-old woman with atrial fibrillation and pulmonary hypertension which were later found to be associated with ALCAPA syndrome. Despite a history free of traditional cardiovascular risk factors, her symptoms included exercise intolerance, palpitations, and an ischemic stroke. Echocardiography and further examination revealed pulmonary artery origin of the left coronary artery and extensive collateral formation between the left and right coronary arteries, contributing to her symptoms.

BACKGROUND:Very-early recurrence of atrial tachyarrhythmia (VERAT) is common after atrial fibrillation (AF) radiofrequency ablation. The association between the burden of VERAT and late recurrence of atrial tachyarrhythmia (LRAT) has not been fully studied. METHODS:Consecutive patients who underwent index AF ablation from September 1, 2020, to August 31, 2023, were enrolled. VERAT was defined as any recurrent atrial tachyarrhythmias within the first 7 days after ablation. All patients were followed up for 12 months. VERAT patients were classified into three groups by cutoff value based on receiver operating characteristic (ROC) curve analysis: without-VERAT, low VERAT burden (< 18.17%), and high VERAT burden (≥ 18.17%). The association between VERAT burden and LRAT was analyzed by Cox regression model. RESULTS:VERAT occurred in 137 of the 503 patients (27.2%). LRAT was observed in 53 patients (10.5%). VERAT burden was higher among LRAT patients. ROC curve revealed a correlation between VERAT burden and LRAT (area under curve 0.654, 95% confidence interval [95% CI] 0.566-0.741, p < 0.001). Compared with without-VERAT group and low VERAT burden group, patients in high VERAT burden group were related to a 5.3-fold (hazard ratio [HR] 5.307, 95% CI 2.909-9.683, p < 0.001) and 3.3-fold (HR 3.276, 95% CI 1.471-7.293, p = 0.004) LRAT risk, respectively. Both VERAT (HR 3.001, 95% CI 1.748-5.154, p < 0.001) and VERAT burden (HR 1.024 per 1% increase, 95% CI 1.014-1.034, p < 0.001) were predictors of LRAT. CONCLUSION:VERAT and its burden were associated with an increased risk of LRAT in AF patients who underwent radiofrequency ablation.

BACKGROUND:Systemic lupus erythematosus (SLE)-associated pulmonary arterial hypertension (PAH) exhibits marked clinical heterogeneity. Although pathogenic variants in the BMPR2 gene and other PAH-related genes drive pulmonary vascular remodeling in idiopathic or familial PAH, their role in SLE-associated PAH remains unclear. RESEARCH QUESTION:What is the prevalence of rare variants in PAH-related genes in patients with SLE-associated PAH and how are these variants associated with clinical phenotypes and outcomes? STUDY DESIGN AND METHODS:Based on the Chinese SLE Treatment and Research Group PAH cohort, 241 patients with SLE-associated PAH were recruited and screened for rare deleterious variants in 12 definitive and 9 candidate PAH-related genes by whole exome sequencing. Clinical features, hemodynamic characteristics, and outcomes were compared between variant carriers and noncarriers. Another 87 patients with SLE-associated PAH were included as a genetic replication cohort. RESULTS:In the discovery cohort, 7.2% of patients carried rare variants in PAH-related genes, a higher trend than in the control cohort (4.5%; P = .085). This trend remained consistent in the independent validation cohort (8.5% vs 4.8%; P = .148) and reached statistical significance in the combined cohort analysis (7.4% vs 4.7%; P = .036). Variant carriers showed a significantly higher proportion of PAH as the onset symptom of SLE and significantly lower SLE disease activity. Carrying rare variants in PAH-related genes was identified as an independent prognostic factor of mortality (hazard ratio, 5.89; 95% CI, 1.56-22.27; P = .009). INTERPRETATION:Our results show that rare variants in PAH-related genes are associated with a distinct vasculopathy phenotype and worse outcomes in patients with SLE-associated PAH, demonstrating the clinical implications of better risk stratification and personalized treatment strategies for patients with SLE-associated PAH.

ICI-associated myocarditis is an uncommon yet potentially fatal condition, particularly when concomitant with atrioventricular block (AVB) necessitating pacing. The role of pacing therapy for ICI-associated AVB remains unknown. The aim of this study is to investigate the efficacy and safety of pacing therapy for ICI-associated AVB. Patients with ICI-associated myocarditis admitted to Peking Union Medical College Hospital from May 1st 2019 to April 30th 2024 were consecutively screened and the patients with AVB requiring pacing therapy were retrospectively included. Baseline clinical characteristics and initial temporary pacing therapy were evaluated. Follow-up assessments were conducted to evaluate the survival rate and the recovery of atrioventricular conduction. A total of 43 patients with ICI-associated myocarditis were screened. Among them, a total of 11 (11/43, 25.6

The extent of improvement in left atrial (LA) function after radiofrequency catheter ablation (RFCA) in patients with paroxysmal atrial fibrillation (PxAF) and its association with heart failure with preserved ejection fraction (HFpEF) remain unclear. This study aims to explore whether there is a difference in the improvement of LA function after RFCA in patients with PxAF combined with HFpEF compared to those without HFpEF. Patients with PxAF receiving RFCA were enrolled. LA volume index (LAVI), LA emptying fraction (LAEF), and LA peak reservoir strain (LA RS) were assessed using echocardiography at baseline and three months after RFCA. Changes in these parameters were compared between patients with a high probability of HFpEF (hp-HFpEF) and those with a medium or low probability of HFpEF (lp-HFpEF), as determined by the H2FPEF score. A total of 147 patients (mean age 62.6 years; 63.3

The prognosis for restrictive cardiomyopathy (RCM) is typically poor, which primarily influenced by the restrictive physiology. This study aimed to evaluate the prognostic significance of longitudinal strains and myocardial work (MW) indices in RCM patients and to create and validate a multivariable model for predicting major adverse cardiac events (MACEs). We enrolled 191 patients with RCM, divided into a training cohort of 128 and a validation cohort of 63, along with 132 healthy controls. Echocardiography was used to assess right ventricular free wall strain (RV-FWS), left ventricular global longitudinal strain (LV-GLS), left atrial peak strain (LAPS), right atrial peak strain (RAPS), and MW indices. Univariate and multivariate stepwise Cox regressions were applied to identify independent prognostic factors and develop a nomogram. With a median follow-up of 977 days, 111 patients experienced MACEs and 76 died. In patients with preserved left ventricular ejection fraction (LVEF), LV-GLS and MW indices were impaired. Longitudinal strains and MW indices were significantly associated with prognosis. We constructed a predictive nomogram including LAPS, RV-FWS, global myocardial work efficiency (GWE), and established clinical predictors, which demonstrated excellent discriminative and calibration properties. Thorough evaluation of longitudinal strains and MW indices is essential, particularly focusing on LAPS, RV-FWS, and GWE.

Primary Sjögren’s syndrome (pSS) was one of the pivotal causes of pulmonary arterial hypertension (PAH) among connective tissue diseases (CTDs) with adverse outcomes, but genetic studies of pSS-PAH are quite limited. Studies have identified genetic predisposition in both familial PAH (fPAH) and idiopathic PAH (iPAH) cases. Therefore, the aim of this study was to explore the genetic susceptibility of PAH in pSS. Forty-three pSS-PAH patients, 92 pSS‐non‐PAH patients, and 105 healthy controls (HC) were obtained. PAH was diagnosed according to the 2015 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines, and ruled out by echocardiogram as estimated PAP < 40 mmHg. Single-nucleotide polymorphism (SNP) sites related to PAH and pSS were selected and then compared between pSS-PAH and pSS-non-PAH groups. In pSS-PAH group, 97.7

OBJECTIVE:Pulmonary arterial hypertension (PAH) is a serious complication of systemic lupus erythematosus (SLE) with high mortality. The ratio of pulmonary to systemic vascular resistance (SVR) (Rp : Rs) may increase with disease progression. However, the prognostic value of Rp : Rs in predicting the outcomes of patients with SLE-PAH remains to be elucidated. METHODS:Between 1 February 2012, and 30 June 2022, consecutive patients with a diagnosis of SLE-PAH and minimum one follow-up were enrolled prospectively. The end points were all-cause mortality and lung transplantation. The predictive values of baseline clinical characteristics and hemodynamic parameters, including Rp : Rs, were analyzed using Cox proportional hazard analyses. C-statistics were used to compare the predictive ability between the models. RESULTS:A total of 285 patients were included and followed up for a median duration of 3.41 (interquartile range 1.81-5.72), during which 58 (20.4%) patients reached the endpoint. Multivariable Cox regression analysis revealed that in addition to the 6-minute walk distance (6MWD), the Rp : Rs was an independent predictor of the endpoint [hazard ratio 24.72; 95% confidence interval (CI) 5.59-109.29, P  < 0.001] in predicting the endpoint. The concordance index for a model incorporating the Rp : Rs and the 6MWD yielded a value of 0.75 (95% CI 0.68-0.82), which showed better predictive accuracy than the simplified risk stratification strategy. Introducing the Rp : Rs ratio to the 2022 ESC/ERS four-stratum model significantly improved its predictive performance for these patients. CONCLUSION:The Rp : Rs serves as an independent predictor of adverse prognosis in patients with SLE-PAH and could provide additional value over current risk-assessment tools.

IntroductionAmyloid light-chain cardiac amyloidosis is a progressive infiltrative disease characterized by the deposition of amyloid fibrils in the cardiac tissue, which can cause serious atrioventricular block requiring pacemaker implantation. Left bundle branch pacing has emerged as an alternative method for delivering physiological pacing to achieve electrical synchrony of the left ventricle. However, left bundle branch pacing in patients with amyloid light-chain cardiac amyloidosis has not been studied in detail. Therefore, in this study, we present a case of left bundle branch pacing in a patient with amyloid light-chain cardiac amyloidosis.Case summaryA 66-year-old male patient with amyloid light-chain cardiac amyloidosis presented with syncope for 1 month. Holter monitoring revealed intermittent third-degree atrioventricular block. Left bundle branch pacing was performed successfully. During the 1-year follow-up, it was observed that the left bundle branch capture threshold remained stable without any pacemaker-related complications or left ventricle systolic dysfunction, and there was no recurrence of syncope.ConclusionLeft bundle branch pacing appears to be a safe and feasible option for patients with amyloid light-chain cardiac amyloidosis experiencing atrioventricular block.

A case of immune checkpoint inhibitors (ICIs)-associated myocarditis with reversible advanced atrioventricular block (AVB) was reported. We innovatively used active fixation lead connected to an external device for prolonged temporary pacing until atrioventricular conduction recovered. Invasive electrophysiology studies were performed to evaluate atrioventricular conduction in detail. Long-term follow-up for nearly 120-days and repeated long-term electrocardiography was conducted to ensure the conduction system was truly recovered.

Background: Left bundle branch area pacing (LBBAP) has been persuasively adopted in clinical practice to achieve electrical and mechanical synchrony of the left ventricle. However, LBBAP in amyloid light chain cardiac amyloidosis (AL-CA) patients has not been studied in detail. Hypothesis: LBBAP could be a feasible and safe approach to rectify the conduction system diseases of AL-CA patients. Aim: To study the feasibility and safety of LBBAP in AL-CA patients. Methods: Consecutive patients with AL-CA and newly implanted pacemaker in our centre between 1st January 2022 and 31st December 2023 were retrospectively included. The diagnosis of AL-CA was confirmed according to the current ESC position statement. Indications for pacemaker fulfilled the current ESC guideline. All patients underwent attempts of LBBAP or right ventricular pacing (RVP) based on operators’ preference. Results: A total of 10 patients were included. RVP was chosen initially in 1 patient and LBBAP was attempted in 9 patients. LBBAP were successfully performed in 6 patients (66.7%, 6/9). Three patients crossed over to RVP group because LBBAP was failed to achieve (Fig.1) . Baseline clinical characteristics and pacing parameters was compared between LBBAP group and RVP group ( Table.1 ). Duration of intrinsic QRS was similar and paced QRS was wider in RVP group ( P =0.029). During follow-up, one patient in LBBAP group died from sudden death 15 days after implantation, while 2 patients in RVP group died from sudden death and pneumonia 55 days and 17 days after implantation, respectively. Seven patients visited our centre at three-month follow-up without adverse events and interrogation reports were summarized in Fig.1 . Conclusion: LBBAP appears to be a reasonable method for physiological pacing for patients with AL-CA and bradycardia, but its impact on long-term prognosis needs further investigation.

Abstract Background Pulmonary arterial hypertension is a major cause of death in systemic lupus erythematosus, but there are no tools specialized for predicting survival in systemic lupus erythematosus-associated pulmonary arterial hypertension. Research question To develop a practical model for predicting long-term prognosis in patients with systemic lupus erythematosus-associated pulmonary arterial hypertension. Methods A prognostic model was developed from a multicenter, longitudinal national cohort of consecutively evaluated patients with systemic lupus erythematosus-associated pulmonary arterial hypertension. The study was conducted between November 2006 and February 2020. All-cause death was defined as the endpoint. Cox regression and least absolute shrinkage and selection operators were used to fit the model. Internal validation of the model was assessed by discrimination and calibration using bootstrapping. Results Of 310 patients included in the study, 81 (26.1%) died within a median follow-up of 5.94 years (interquartile range 4.67–7.46). The final prognostic model included eight variables: modified World Health Organization functional class, 6-min walking distance, pulmonary vascular resistance, estimated glomerular filtration rate, thrombocytopenia, mild interstitial lung disease, N-terminal pro-brain natriuretic peptide/brain natriuretic peptide level, and direct bilirubin level. A 5-year death probability predictive algorithm was established and validated using the C-index (0.77) and a satisfactory calibration curve. Risk stratification was performed based on the predicted probability to improve clinical decision-making. Conclusions This new risk stratification model for systemic lupus erythematosus-associated pulmonary arterial hypertension may provide individualized prognostic probability using readily obtained clinical risk factors. External validation is required to demonstrate the accuracy of this model's predictions in diverse patient populations.

Abstract Growth‐differentiation factor (GDF)‐15 is a member of transforming growth factor‐β‐related cytokine and may respond to right ventricular overload. The objective of this article was to assess the diagnosis and prognostic value of GDF‐15 in systemic lupus erythematosus‐associated pulmonary arterial hypertension (SLE‐PAH). Serum samples were obtained from 65 patients with SLE‐PAH, 51 sex and age matched patients of SLE without PAH (SLE‐non‐PAH), and 32 healthy controls. Serum GDF‐15 level was detected by enzyme‐linked immunosorbent assay and the optimal cut‐off point was determined by receiver operating characteristic curve. The primary end‐point was death from any cause and the secondary end‐point was target goal achievement (TGA). Cox regression analyses and Kaplan−Meier method were performed to identify the prognostic value of GDF‐15. Serum GDF‐15 levels were significantly higher in SLE‐PAH patients (1112.14 ± 781.80 pg/mL) than SLE‐non‐PAH patients (810 ± 408 pg/mL) and healthy controls (442 ± 139 pg/mL) at baseline. The optimal cut‐off value of GDF‐15 in the diagnosis of SLE‐PAH was 733 pg/mL (AUC = 0.84). In patients with SLE‐PAH, GDF‐15 level was associated with 6 min walking distance (ρ = −0.385, p = 0.017) and higher serum N terminal‐pro brain natriuretic peptide (NT‐proBNP) (ρ = 0.605, p < 0.001). Patients with GDF‐15 > 733 pg/mL were more likely to death (adjusted hazard ratio [HR] = 4.01, 95% confidence intervals [CI]: 1.23−6.27, p = 0.041) and less likely to achieve treatment goal (adjusted HR = 0.57, 95% CI: 0.23−0.79, p = 0.028). In addition, patients with simultaneous elevation of GDF‐15 and NT‐proBNP showed lower proportion of TGA (p = 0.046). In conclusion, GDF‐15 is a new and promising biomarker of development and prognosis in SLE‐PAH. The combination of GDF‐15 and NT‐proBNP may provide more accurate prognostic information.

Background Radiofrequency ablation (RFA) is a widely used treatment for atrial fibrillation, reducing the risk of cardiac arrhythmia. Detailed visualization and quantification of atrial scarring has the potential to improve preprocedural decision-making and postprocedural prognosis. Conventional bright-blood late gadolinium enhancement (LGE) MRI can help detect atrial scars; however, its suboptimal myocardium to blood contrast inhibits accurate scar estimation. Purpose To develop and test a free-breathing LGE cardiac MRI approach that simultaneously provides high-spatial-resolution dark-blood and bright-blood images for improved atrial scar detection and quantification. Materials and Methods A free-breathing, independent navigator-gated, dark-blood phase-sensitive inversion recovery (PSIR) sequence with whole-heart coverage was developed. Two coregistered high-spatial-resolution (1.25 × 1.25 × 3 mm3) three-dimensional (3D) volumes were acquired in an interleaved manner. The first volume combined inversion recovery and T2 preparation to achieve dark-blood imaging. The second volume functioned as the reference for phase-sensitive reconstruction with built-in T2 preparation for improved bright-blood contrast. The proposed sequence was tested in prospectively enrolled participants who had undergone RFA for atrial fibrillation (mean time since RFA, 89 days ± 26 [SD]) from October 2019 to October 2021. Image contrast was compared with conventional 3D bright-blood PSIR images using the relative signal intensity difference. Furthermore, native scar area quantification obtained from both imaging approaches was compared with measurements obtained with electroanatomic mapping (EAM) as the reference standard. Results A total of 20 participants (mean age, 62 years ± 9; 16 male) who underwent RFA for atrial fibrillation were included. The proposed PSIR sequence successfully acquired 3D high-spatial-resolution volumes in all participants, with a mean scan time of 8.3 minutes ± 2.4. The developed PSIR sequence improved scar to blood contrast compared with conventional PSIR sequence (mean contrast, 0.60 arbitrary units [au] ± 0.18 vs 0.20 au ± 0.19, respectively; P < .01) and correlated with EAM regarding scar area quantification (r = 0.66 [P < .01] vs r = 0.13 [P = .63]). Conclusion In participants who had undergone RFA for atrial fibrillation, an independent navigator-gated dark-blood PSIR sequence produced high-spatial-resolution dark-blood and bright-blood images with improved image contrast and native scar quantification compared with conventional bright-blood images. © RSNA, 2023 Supplemental material is available for this article.

OBJECTIVE:Pulmonary arterial hypertension (PAH) is a severe complication of systemic lupus erythematosus (SLE). However, the genetic signatures of SLE-associated PAH have not been well studied. We aimed to identify genetic variants implicated in SLE-associated PAH susceptibility within the major histocompatibility complex (MHC) region and assess the contribution to clinical outcomes.METHODS:A total of 172 patients with SLE-associated PAH confirmed by right heart catheterization, 1,303 patients with SLE without PAH, and 9,906 healthy controls were included. Deep sequencing of the MHC region was performed to identify alleles, single-nucleotide polymorphisms, and amino acids. We compared patients with SLE-associated PAH with patients with SLE without PAH and healthy controls. Clinical association study was conducted to explore the contribution to phenotypes.RESULTS:A total of 19,881 genetic variants were identified within the MHC region. HLA-DQA1*03:02 was identified as a novel genetic variant associated with SLE-associated PAH in the discovery cohort (P = 5.68 × 10-12 ) and authenticated in an independent replication cohort (P = 1.30 × 10-9 ). The strongest associated amino acid position was mapped to HLA-DQα1 in the region affecting MHC/peptide-CD4+ T cell receptor affinity and antigen binding. Clinical association study demonstrated that patients with SLE-associated PAH with HLA-DQA1*03:02 had significantly lower rates of target role achievement (P = 0.005) and survival (P = 0.04).CONCLUSION:This study, based on the largest cohort of SLE-associated PAH, is the first to investigate how MHC region genetic variants contribute to SLE-associated PAH susceptibility. HLA-DQA1*03:02 is a novel genetic risk factor and a prognostic factor in SLE-associated PAH. Patients with SLE with this allele require regular monitoring and careful follow-up for early diagnosis and interventions for potential PAH.

Backgrounds The EmPHasis-10 questionnaire is a disease-specific quality of life (QoL) measurement in patients with pulmonary hypertension. We report the results of cross-cultural validation of the Chinese version of the EmPHasis-10 and its relationship with risk stratification in patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH). Methods The Emphasis-10 was administered to 75 CTD-PAH patients along with the 36-item Medical Outcomes Study Short Form Survey (SF-36) and EuroQol five dimensions questionnaire (EQ-5D). The diagnosis of PAH was confirmed by right heart catheterization. Demographic and clinical data were obtained. Multivariable logistic regression was conducted based on the low risk profile assessed by a 4-strata risk assessment model (COMPERA 2.0) at follow-up. Results Date from 75 patients with CTD-PAH were analysed. The EmPHasis-10 demonstrated satisfactory reliability (Cronbach α = 0.95) and convergent validity showed by the significant relationship with WHO Functional Class ( P = 0.003), SF-36 ( P < 0.001) and EQ-5D (P = 0.002). EmPHasis-10 was significantly associated with achieving the low risk profile at 12 months of follow-up (Odds ratio: 0.928, P = 0.029) after adjusting for WHO Functional Class. Conclusion EmPHasis-10 has acceptable reliability and validity in CTD-PAH patients and may serve as an additional parameter in risk stratification.

Background: Low voltage zones (LVZ) are associated with poor outcomes in patients with atrial fibrillation (AF). The APPLE and DR-FLASH scores predict LVZ in patients undergoing catheter ablation. This study aimed to assess the relationship of mitral valve regurgitation (MR) and LVZ after adjusting for APPLE or DR-FLASH scores. Methods: This was a retrospective study on patients with AF who underwent their first catheter ablation. All patients underwent a transthoracic echocardiographic examination before ablation. The APPLE and DR-FLASH scores were calculated at baseline. LVZ determined by high-density mapping was defined as bipolar voltage amplitude 0.5 mV. LVZ presence was defined as LVZ covering 5% of the left atrial surface area. Results: Altogether, 152 patients (mean age 62.0 +/- 10.8 years, 65.8% men, and 36.2% with persistent AF) were included. Of the 152 patients, 47 (30.9%) had LVZ. The patients with LVZ had more moderate-to-severe MR (17.0% vs. 3.8%, P = 0.014) and higher APPLE scores (1.7 +/- 1.1 vs. 1.2 +/- 1.1, P = 0.009) and DR-FLASH scores (3.0 +/- 1.5 vs. 2.4 +/- 1.4, P = 0.010). Using multivariate logistic regression analysis, we found moderate-tosevere MR was related to LVZ presence after adjusting for the APPLE (OR 4.040, P = 0.034) or DR-FLASH (OR 4.487, P = 0.020) scores. Furthermore, moderate-to-severe MR had an incremental predictive value for LVZ presence in addition to the APPLE (P = 0.03) or DR-FLASH (P = 0.02) scores. Conclusion: In patients with AF, MR severity was related to LVZ after adjusting the APPLE score or DR-FLASH score.

OBJECTIVESThe aim of this study was to investigate the clinical features and outcomes of systemic lupus erythematosus (SLE) with myocarditis.METHODSA retrospective study was conducted in all inpatients diagnosed with SLE and concurrent lupus myocarditis (LM) at Peking Union Medical College Hospital (PUMCH) from July 2013 to July 2019. The case group included patients with LM while patients in the control group were enrolled randomly at a ratio of 1:1 and age- and year-matched SLE patients without myocarditis during the same period. Clinical characteristics and outcomes of LM patients were collected.RESULTSAmong 4719 SLE patients hospitalized to PUMCH over the 6-year period, 79 (1.67%) were diagnosed with LM, with a mean age of 32.38 ± 13.55 years and 89% were female. 52 (66%) cases presented abnormal ventricular wall motion function, and 30 (38%) cases showed a decreased left ventricular ejection fraction (LVEF) (<50%) in echocardiography. 10 (13%) LM patients died during hospitalisation. For risk factors of myocarditis, patients in the LM group had higher percentage of on neurological involvement, higher SLE disease activity index 2000 (SLEDAI-2K) scores, and higher rates of positive anti-nucleosome antibodies compared with the control group. Multivariate logistic regression demonstrated that low levels of C3 and high SLEDAI-2K scores were the independent risk factors for developing LM in SLE patients (OR=0.870, 95%CI 0.762-0.994, p=0.041; OR=1.058, 95%CI 1.008-1.110, p=0.023, respectively).CONCLUSIONSCardiac involvement especially myocarditis in SLE remains a rare but serious manifestation. Our research provided further insights into clinical features and risk factors of LM. Clinicians should be alerted for LM after cardiac manifestations occurred among those with SLE, which may reduce the risk of death.