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Cardiac disease in systemic lupus erythematosus: prospective study of 70 patients
1Department of Internal Medicine, Hospital Clínic i Provincial, Barcelona, Spain.
Insights
Echocardiography reveals significant cardiac abnormalities in 57% of systemic lupus erythematosus (SLE) patients, including valvular issues and pericardial effusion, often without clinical symptoms. Antiphospholipid antibodies are linked to these heart conditions in SLE patients.
Area of Science:
- Cardiology
- Rheumatology
- Internal Medicine
Background:
- Systemic lupus erythematosus (SLE) is an autoimmune disease with potential multi-organ involvement.
- Cardiac manifestations are common in SLE but often subclinical.
- Echocardiography is a key imaging modality for assessing cardiac structure and function.
Purpose of the Study:
- To evaluate the prevalence and types of cardiac abnormalities in SLE patients using echocardiography.
- To compare echocardiographic findings in SLE patients with a healthy control group.
- To investigate the association between antiphospholipid antibodies and cardiac lesions in SLE.
Main Methods:
- Prospective study involving 70 SLE patients and 40 controls.
- Two-dimensional and Doppler echocardiography performed on all participants.
- Analysis of valvular abnormalities, pericardial effusion, and myocardial abnormalities.
Main Results:
- 57% of SLE patients exhibited echocardiographic disturbances compared to 5% in controls.
- Valvular abnormalities (44%) and pericardial effusion (27%) were frequent in SLE patients.
- Antiphospholipid antibodies correlated with a higher prevalence of endocardial lesions, particularly valvular regurgitation.
Conclusions:
- Echocardiography is crucial for detecting subclinical cardiac abnormalities in SLE patients.
- Valvular disease, especially mitral regurgitation, is a significant finding in SLE.
- Antiphospholipid antibodies may play a key role in the pathogenesis of heart valve disease in SLE.
Abstract:
A prospective two dimensional and Doppler echocardiographic study of 70 consecutive patients with systemic lupus erythematosus (SLE) and 40 controls was carried out. Forty patients (57%) were found to have echocardiographic disturbance. Valvular abnormalities were detected in 31 patients (44%) and in only two controls (5%). Mitral valve abnormalities were the most common findings (23/70 (33%)) with mild or moderate regurgitation the most frequent lesion (16% and 9% respectively). Three patients (4%) had a morphological echocardiographic pattern suggestive of non-infective verrucous vegetations affecting the mitral valve. No patient had haemodynamically significant clinical valve disease. Pericardial effusion was identified in 19 patients (27%), of whom 14 had mild and clinically silent disease. Myocardial abnormalities were found in 14 patients (20%), but clinical features of myocardial dysfunction were present in only one. Patients with antiphospholipid antibodies were found to have an increased prevalence of endocardial lesions, mainly valvular regurgitation. It is concluded that the inclusion of echocardiography in a study protocol of patients with SLE can identify an important subset of patients with cardiac abnormalities, many of which are clinically silent. In addition, the association of antiphospholipid antibodies with endocardial lesions suggests that these antibodies may have a prominent role in the pathogenetic mechanisms of heart valve disease in SLE.