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Heart failure as presenting manifestation of cardiac involvement in systemic lupus erythematosus

N E van der Laan-Baalbergen1, S A Mollema, H Kritikos

  • 1Deptartment of Rheumatology, Leiden University Medical Center, the Netherlands.

The Netherlands Journal of Medicine
|October 21, 2009
PubMed

Insights

Heart failure is a rare but serious complication of systemic lupus erythematosus (SLE). Prompt, aggressive treatment, including immunosuppressants, can lead to excellent long-term outcomes for SLE patients with heart failure.

Area of Science:

  • Cardiology
  • Rheumatology
  • Systemic Lupus Erythematosus

Background:

  • Heart failure is an uncommon manifestation of cardiac involvement in systemic lupus erythematosus (SLE).
  • The long-term prognosis for SLE patients experiencing heart failure remains largely unknown.
  • This study aimed to analyze the long-term outcomes of SLE patients with heart failure as the initial cardiac manifestation.

Observation:

  • Six SLE patients presented with heart failure, confirmed by echocardiography showing reduced left ventricular ejection fraction (LVEF) between 23-37%.
  • Literature review identified 21 additional cases of SLE-related heart failure, mostly with favorable short-term outcomes.
  • The observed patients received aggressive treatment including high-dose glucocorticoids, cytotoxic agents (cyclophosphamide or azathioprine), and IVIG.

Findings:

  • Aggressive treatment, including immunosuppressive therapy and inotropic support, led to complete symptom resolution and improved LVEF in the studied SLE patients.
  • Mean follow-up was 77 months (range 43-113 months), demonstrating sustained positive outcomes.
  • Reported cases indicate that immunosuppressive therapy generally leads to favorable short-term outcomes in SLE-associated heart failure.

Implications:

  • Heart failure, though rare, is a life-threatening condition in SLE patients.
  • Prompt and aggressive immunosuppressive treatment is crucial for achieving excellent long-term outcomes in SLE-related heart failure.
  • Early diagnosis and intervention can significantly improve the prognosis for cardiac involvement in systemic lupus erythematosus.
Abstract

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