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Pulmonary hypertension in systemic lupus erythematosus: echocardiography-based definitions predict 6-year survival
Claudia Hübbe-Tena1, Selma Gallegos-Nava1, Ricardo Márquez-Velasco1
1Department of Rheumatology, Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Department of Dermatology, Hospital General de Zona 1-A Dr Rodolfo Antonio de Mucha Macías, Instituto Mexicano del Seguro Social, Division of Research, Department of Echocardiography and Cardio Respiratory Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
Insights
Echocardiography definitions for pulmonary hypertension (PH) can predict long-term survival in patients with systemic lupus erythematosus (SLE). Echocardiography-based PH assessment aids in identifying SLE patients at higher risk for mortality.
Area of Science:
- Cardiology
- Rheumatology
- Pulmonology
Background:
- Pulmonary hypertension (PH) is a serious complication in patients with systemic lupus erythematosus (SLE).
- Accurate prediction of long-term survival in SLE patients with PH is crucial for clinical management.
Purpose of the Study:
- To evaluate the utility of echocardiography-based definitions of PH, proposed by ESC/ERS/ISHLT, in predicting long-term survival in SLE patients.
- To identify clinical factors associated with PH in SLE.
Main Methods:
- A post hoc analysis of 6-year follow-up data from a cohort of 55 SLE patients was conducted.
- Patients were categorized into unlikely, possible, or likely PH groups based on echocardiography criteria.
- Survival rates, all-cause mortality, clinical associations, serum biomarkers, and autoantibody profiles were assessed.
Main Results:
- The 'likely PH' group showed a significantly lower 6-year survival rate (68%) compared to the 'unlikely' (88%) and 'possible' (87%) PH groups (P < 0.05).
- Likely PH was associated with a history of pulmonary thromboembolism, higher cumulative organ damage, and active arthritis.
- No significant differences in tested serum biomarkers or autoantibodies were observed between the groups.
Conclusions:
- Echocardiography-based PH definitions by ESC/ERS/ISHLT effectively predict 6-year mortality in SLE patients.
- Pulmonary thromboembolism, lung vasculitis/hemorrhage, cumulative organ damage, and disease duration are linked to PH in SLE.
Objective:
The aim of this study was to investigate whether a core of echocardiography-based definitions of pulmonary hypertension (PH), as proposed by the European Society of Cardiology, European Respiratory Society and International Society of Heart and Lung Transplantation (ESC/ERS/ISHLT), may predict long-term survival in patients with SLE.
Methods:
A post hoc analysis from a cohort of SLE patients followed over 6 years was performed. Clinical associations, serum biomarkers, autoantibody profile, length of survival and all-cause mortality were assessed.
Results:
Out of 115 patients from the original cohort, 55 satisfied our inclusion criteria and were grouped according to echocardiography as unlikely (n = 26), possible (n = 16) or likely (n = 13) to have PH. Likely PH was associated with a history of pulmonary thromboembolism, higher cumulated organ damage and active arthritis. The 6-year survival rate was 88% in the unlikely PH group, 87% in the possible PH group and 68% in the likely PH group (P < 0.05). Serum levels of endothelin-1, monocyte chemotactic protein-1, IL-17, and IFN-γ as well as a number of autoantibodies were no different between groups.
Conclusion:
The ESC/ERS/ISHLT echocardiography-based definitions of PH are useful to predict 6-year mortality in SLE patients. A history of pulmonary thromboembolism and lung vasculitis/haemorrhage, cumulated organ damage and long-lasting disease are associated with PH in SLE.
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