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[Echocardiographic analysis of changes in the heart in patients with systemic lupus erythematosus]
A Smalcelj1, Z Durakovic, I Cukusić
1Klinike za unutrasnje bolesti Medicinskog fakulteta i Klinickog bolnickog centra u Zagrebu.
Insights
Pericardial effusion and thickening are common in systemic lupus erythematosus (SLE) patients. Diffuse myocardial involvement is rare, but Libman-Sacks endocarditis remains a diagnostic challenge.
Area of Science:
- Cardiology
- Rheumatology
- Medical Imaging
Context:
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease affecting multiple organ systems.
- Cardiac involvement in SLE can range from pericarditis to valvular disease and myocardial dysfunction.
- Echocardiography is a key non-invasive tool for assessing cardiac structure and function.
Purpose:
- To evaluate the prevalence and spectrum of cardiac abnormalities in patients with systemic lupus erythematosus using echocardiography.
- To identify specific echocardiographic findings associated with SLE, including pericardial disease, valvular lesions, and myocardial function.
- To assess the diagnostic challenges of Libman-Sacks endocarditis in SLE patients.
Summary:
- Echocardiographic examination of 56 SLE patients revealed pericardial effusion in 27% and thickening in 37.5%.
- Libman-Sacks endocarditis was suspected in 7.5% of patients. Left ventricular hypertrophy was observed in 37.5%, and myocardial hypocontractility was infrequent.
- Pulmonary hypertension was detected in 3.6% of cases. Pericardial involvement is frequent, while diffuse myocardial disease is uncommon in SLE.
Impact:
- Highlights the high frequency of pericardial involvement in SLE, emphasizing the need for routine echocardiographic screening.
- Underscores the diagnostic difficulties associated with Libman-Sacks endocarditis, suggesting further research for improved detection.
- Provides insights into the pattern of cardiac manifestations in SLE, differentiating between pericardial and myocardial involvement.
Abstract:
Fifty-six patients, 49 females and 7 males, with the confirmed diagnosis of systemic lupus erythematosus were examined by M-mode, 2--D and Doppler echocardiography. Pericardial effusion was found in 15 patients (27%), while pericardial thickening was suspected in 6 additional patients (37.5% altogether). Two patients had the signs of a pericardial tamponade, but both of them were uraemic. Libman-Sacks endocarditis was suspected in 4 patients (7.5%) because of verrucous changes in the aortic or mitral valve and regurgitant jet. Slight to moderate left ventricular hypocontractility was present in 3 patients (5%), while 3 additional patients had borderline values of the left ventricular contractility parameters. Left ventricular hypertrophy, usually mild, was found in 21 patients (37.5%). Echocardiographic signs of pulmonary hypertension were present in 2 patients (3.6%). It has been concluded that pericardial affection is frequent during the course of systemic lupus erystematosus, while a diffuse myocardial involvement is rare, except the consequences of arterial hypertension and accelerated coronary atherosclerosis. Libman-Sacks endocarditis still represents a diagnostic problem. For a more precise definition of cardiac involvement in systemic lupus erythematosus, a comparative analysis of the disease activity and immunosuppressive therapy is needed.