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Cardiovascular disease in systemic lupus erythematosus. A study of 75 patients form a defined population
G Sturfelt1, J Eskilsson, O Nived
1Department of Rheumatology, University Hospital of Lund, Sweden.
Insights
Systemic lupus erythematosus patients show increased cardiac issues, including valvular disease and myocardial infarction, linked to IgG anticardiolipin antibodies. Prolonged glucocorticoid use was also associated with these cardiac complications.
Area of Science:
- Cardiology
- Rheumatology
- Immunology
Background:
- Systemic lupus erythematosus (SLE) is an autoimmune disease with potential multi-organ involvement.
- Cardiac complications are a significant concern in SLE patients, impacting morbidity and mortality.
Purpose of the Study:
- To investigate cardiac function in patients with SLE.
- To explore the association between cardiac abnormalities and IgG anticardiolipin antibodies (IgG aCL).
Main Methods:
- Prospective study of 101 SLE patients, with 75 undergoing detailed cardiac investigations.
- Methods included echocardiography, Doppler cardiography, ECG (rest and exercise), and myocardial scintigraphy.
- ELISA was used to determine IgG aCL levels.
Main Results:
- 27% of patients had valvular disease, with 60% of these showing elevated IgG aCL (p<0.01).
- 19% had pericardial effusion, and 16% had mild pulmonary hypertension, both associated with increased IgG aCL.
- Myocardial infarction occurred in 7 patients, with prolonged glucocorticoid treatment linked to valvular abnormalities and myocardial infarction. Valvular abnormalities and IgG aCL were identified as risk factors for cerebral infarction.
Conclusions:
- Cardiac involvement, including valvular disease and myocardial infarction, is prevalent in SLE patients.
- Elevated IgG aCL is significantly associated with valvular disease and may indicate increased cardiovascular risk.
- Glucocorticoid therapy and IgG aCL are potential risk factors for adverse cardiac and cerebrovascular events in SLE.
Abstract:
All patients with systemic lupus erythematosus in a prospective, epidemiologically based study within a defined area in southern Sweden were invited to participate in an investigation of cardiac function. From 1981 to 1988, 101 patients were included in the study, and 75 of them were investigated according to a fixed protocol by echocardiography, Doppler cardiography, electrocardiography (ECG) at rest and at exercise, and myocardial scintigraphy (in patients whose ECG became abnormal during exercise). IgG anticardiolipin antibodies (IgG aCL) were determined by ELISA. Twenty of the 75 patients (27%) had valvular disease and 12 of these (60%) had increased concentrations of IgG aCL, compared with 12 of 55 (22%) without valvular disease (p less than 0.01). Pericardial effusion was detected in 14 patients (19%) during the study period. Mild pulmonary hypertension was found in 11 patients (16%), who also had increased frequency of IgG aCL. Myocardial infarction had occurred in 7 patients, 3 of whom were women less than 40 years of age. Echocardiography revealed regional hypokinesis or akinesis in 5 of the patients with myocardial infarction. Exercise testing revealed low work capacity in 13 of 54 patients (24%), the limiting symptoms being mainly exhaustion or musculoskeletal pain. An abnormal resting ECG was found in 9 of the patients participating in the exercise test. During exercise, abnormal ST-depression was observed in 8 patients, 2 of whom developed angina. Myocardial scintigraphy was performed in 6 of these patients, revealing reversible uptake defects in all. Prolonged glucocorticoid treatment was associated with valvular abnormalities as well as myocardial infarction. Valvular abnormalities and IgG aCL appeared to be risk factors for cerebral infarction.