Despite major achievements in understanding the pathobiology and management of Systemic Lupus Erythematosus (SLE), cardio-vascular burden remains a complex challenge in routine practice. Echocardiography emerges as a valuable non-invasive technique widely recommended for the screening, evaluation and monitoring of cardiac involvement in different SLE settings.
Objectives to evaluate the prevalence and nature of the clinical and subclinical cardiac involvement in SLE, and to identify potential relation with several disease-related parameters.
Design and methods Retrospective observational study in 120 consecutive SLE (fulfilling either 1987 ACR or new 2012 SLICC/ACR criteria), mean age 36.9+15.2 years and mean disease duration 9.2+8.5 years, attending the outpatient rheumatology department at least once. Demographic, clinical, immunologic profile, disease activity (SLEDAI), organ damage (SLICC/ACR) data were collected.
Patients were assessed according to a standardised protocol focused on clinical, immunologic profile, disease activity (SLEDAI), severity and organ damage (SLICC/ACR); cardiac involvement (valve damage, systolic and diastolic dysfunction, pericardial disease, myocardial ischemia, pulmonary hypertension) was evaluated by 2D transthoracic echocardiography (TTE).
Statistical analysis was done in SPSS, p<0.05.
Results Valvular disease was reported in 61.98% SLE (14% stenosis, 20.66% valvular masses, 33% mild-to- moderate regurgitation, 34.73% leaflet thickening. Libman-Sacks endocarditis was not depicted. Asymptomatic decrease in left ventricular ejection fraction (55%) was described in 16.52%, the lowest LVEF being 33% in 4.13% patients; statistical significant negative correlation LVEF – disease duration and activity (p<0.05) was found. LV diastolic dysfunction as subclinical cardiac involvement was registered in 59.50% SLE, with a direct correlation with disease duration (p<0.05), but not with disease activity (SLEDAI) and organ damage (SLIC/ACR) (p>0.05). Global hypokinesis on TTE as an indicator of subclincal myocarditis was demonstrated in up to one third SLE, while cardiomyopathy in one fourth. Mild pericardial effusion is observed in 31.2% cases, while cardiac tamponade in 4 cases; pericardial thickening was reported in 38% SLE. Finally, abnormal systolic pressure in pulmonary artery was found in 24.79% patients.
Conclusion Patients with SLE are at increased risk to develop either clinical or subclinical cardiovascular manifestations as demonstrated by echocardiographic studies. A systematic TTE assessment is routinely recommended for the screening and monitoring of cardiac events.
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