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The early cardiovascular changes in pediatric patients with systemic lupus erythematosus
Betul Sozeri1, Murat Deveci, Nida Dincel
1Department of Pediatric Rheumatology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey. betulsozeri@yahoo.com
Insights
Pediatric patients with Systemic Lupus Erythematosus (SLE) exhibit early cardiovascular changes (CVCs) independent of traditional risk factors. These functional and morphological CVCs correlate with SLE disease activity, highlighting the need for early monitoring.
Area of Science:
- Cardiovascular Medicine
- Pediatric Rheumatology
- Immunology
Background:
- Systemic Lupus Erythematosus (SLE) is associated with increased cardiovascular morbidity and mortality.
- Inflammatory and immune mechanisms in SLE contribute to atherosclerosis and cardiovascular changes (CVCs).
- The presence and impact of CVCs in pediatric SLE patients require investigation.
Purpose of the Study:
- To assess functional and morphological cardiovascular changes in pediatric SLE patients.
- To determine if these changes are independent of traditional cardiovascular risk factors.
- To explore the correlation between cardiovascular changes and SLE disease activity.
Main Methods:
- Study included 51 pediatric SLE patients and 25 healthy controls.
- Arterial stiffness assessed using carotid-femoral pulse wave velocity (PWVcf) and augmentation index (AIx).
- Carotid intima-media thickness (cIMT) and left ventricular mass index (LVMi) were measured.
Main Results:
- SLE patients showed significantly higher PWVcf, AIx, cIMT, and LVMi compared to controls.
- These differences persisted despite similar exposure to traditional cardiovascular risk factors.
- Cardiovascular parameters correlated significantly with SLE disease activity scores.
Conclusions:
- Pediatric SLE patients exhibit early functional and morphological cardiovascular changes.
- These changes are independent of traditional cardiovascular risk factors.
- Cardiovascular changes in early-stage pediatric SLE correlate with disease activity.
Background:
In patients with systemic lupus erythematous (SLE) late-onset deaths are due to morbid cardiovascular changes (CVCs). Inflammatory and immune-mediated mechanisms are involved in promoting atherosclerosis development in SLE that is reflected in both functional and morphological changes in the cardiovascular system. The aim of our study was to determine the presence of these changes in pediatric SLE patients.
Methods:
Fifty-one consecutive patients (13 male, 38 female) with SLE and 25 healthy controls were included in the study. Arterial stiffness was assessed by carotid-femoral pulse wave velocity (PWVcf) and augmentation index (AIx), as measured by the Vicorder. Carotid intima-media thickness (cIMT) and the left ventricular mass index (LVMi) were also determined.
Results:
Patients with SLE, despite equivalent exposure to "traditional" cardiovascular risk factors, presented a higher mean PWVcf and AIx than controls (6.56 ± 1.45 vs. 5.29 ± 0.67 m/s, P =0.01 and 14.7 ± 8.1 vs. 9.36 ± 3.59 %, P = 0.02, respectively). SLE patients had greater values of cIMT and LVMi than controls (0.54 ± 0.06 vs. 0.35 ± 0.12 mm, P = 0.00 and 32.4 ± 10.8 vs 28.8 ± 1.5, P = 0.01, respectively). Nine patients had left ventricular hypertrophy (LVMi >38 g/m(2.7)). There was no significant difference in PWV, AIx, cIMT and LVMi values between presence of hypertension or nephritis within SLE patients. We found significant correlations between all parameters and activity scores.
Conclusions:
Our results demonstrate that functional and morphological CVCs are independent of traditional risk factors in pediatric SLE patients and correlate with SLE disease activity scores in the early disease stages.
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