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Cardiac involvement in systemic lupus erythematosus
A Doria1, L Iaccarino, P Sarzi-Puttini
1Division of Rheumatology, University of Padua, Padua, Italy. adoria@unipd.it
Insights
Systemic lupus erythematosus (SLE) patients commonly experience pericarditis and other cardiac issues. Echocardiography is vital for early detection of these conditions, aiding in timely management and improved patient outcomes.
Area of Science:
- Cardiology
- Rheumatology
- Internal Medicine
Background:
- Pericarditis is the most frequent cardiac abnormality in patients with systemic lupus erythematosus (SLE).
- Historically, cardiac manifestations in SLE were severe and life-threatening, often discovered post-mortem.
- Contemporary understanding reveals that cardiac involvement in SLE is frequently mild and asymptomatic, detectable through noninvasive methods.
Purpose of the Study:
- To highlight the prevalence and nature of cardiac abnormalities in SLE.
- To emphasize the diagnostic utility of echocardiography in SLE patients.
- To discuss the mechanisms and management of cardiovascular complications in SLE.
Main Methods:
- Review of clinical observations and diagnostic techniques for cardiac manifestations in SLE.
- Focus on the role of echocardiography in identifying pericarditis, valvular lesions, and myocardial dysfunction.
- Analysis of causes for vascular occlusion, including premature atherosclerosis and antiphospholipid antibodies in SLE.
Main Results:
- Echocardiography demonstrates high sensitivity and specificity for detecting cardiac abnormalities in SLE, including mild pericarditis.
- Vascular complications, such as coronary artery disease (CAD), are common in SLE patients, primarily driven by premature atherosclerosis.
- Cardiac manifestations in SLE are now often mild and asymptomatic, contrasting with historical severe presentations.
Conclusions:
- Periodic echocardiography is recommended for SLE patients to monitor for cardiac abnormalities.
- Managing traditional and SLE-specific risk factors is crucial to prevent atherosclerotic plaque development and CAD.
- Early detection and management of cardiac involvement are essential for improving outcomes in SLE patients.
Abstract:
Pericarditis is the most common cardiac abnormality in systemic lupus erythematosus (SLE) patients, but lesions of the valves, myocardium and coronary vessels may all occur. In the past, cardiac manifestations were severe and life threatening, often leading to death. Therefore, they were frequently found in post-mortem examinations. Nowadays cardiac manifestations are often mild and asymptomatic. However, they can be frequently recognized by echocardiography and other noninvasive tests. Echocardiography is a sensitive and specific technique in detecting cardiac abnormalities, particularly mild pericarditis, valvular lesions and myocardial dysfunction. Therefore, echocardiography should be performed periodically in SLE patients. Vascular occlusion, including coronary arteries, may develop due to vasculitis, premature atherosclerosis or antiphospholipid antibodies associated with SLE. Premature atherosclerosis is the most frequent cause of coronary artery disease (CAD) in SLE patients. Efforts should be made to control traditional risk factors as well as all other factors which could contribute to atherosclerotic plaque development.
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