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Heart involvement in systemic lupus erythematosus: a systemic review and meta-analysis
Junzhe Chen1, Ying Tang1, Mingsheng Zhu1
1Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan-Jiang Xi Road, Guangzhou, 510120, China.
Insights
Systemic lupus erythematosus (SLE) patients show significant cardiac abnormalities, including pericardial effusion and valvular alterations, as detected by echocardiography. These findings highlight the need for routine cardiac screening in SLE management.
Area of Science:
- Cardiology
- Rheumatology
- Medical Imaging
Background:
- Cardiovascular diseases are a major cause of mortality and disability in patients with systemic lupus erythematosus (SLE).
- Echocardiography is a key imaging modality for assessing cardiac structure and function.
Purpose of the Study:
- To systematically review and meta-analyze echocardiographic findings in SLE patients.
- To identify specific cardiac abnormalities associated with SLE.
Main Methods:
- A systematic review and meta-analysis of case-control studies.
- Searched databases: PubMed MEDLINE, Embase, and MD Consult.
- Included 22 studies with 1117 SLE patients and 901 controls.
Main Results:
- SLE patients had significantly higher odds of pericardial effusion (OR 30.52) and valvular alterations (OR 11.08).
- Increased left atrial diameter, left ventricular internal diameter in diastole, and left ventricular mass index were observed.
- Decreased left ventricular systolic and diastolic function (E/A and E/E' ratios) were noted in SLE patients.
Conclusions:
- SLE is associated with significant alterations in cardiac structure and function.
- Echocardiographic assessment should be a routine part of clinical evaluation for SLE patients.
Abstract:
Cardiovascular diseases are one of the most important causes of the disability and mortality in patients with systemic lupus erythematosus (SLE). The present study examined the cardiac abnormalities in patients with SLE by echocardiography. Case-control studies were obtained by searching PubMed MEDLINE, Embase, and MD Consult. Systemic review and meta-analysis were performed to assess the cardiac abnormalities based on the changes in the echocardiography in patients with SLE. Twenty-two studies including 1117 SLE patients and 901 healthy controls were enrolled into this study. We found that patients with SLE developed the pericardial effusion (odds ratio (OR) (95 % confidence interval (CI)) 30.52 (9.70-96.02); p < 0.00001) and the combined valvular alterations (OR (95 %CI) 11.08 (6.98-17.59); p < 0.00001). In addition, SLE patients also exhibited an increase in the left atrial diameter (LAD) (WMD-weighted mean difference (95 %CI) 0.18 (0.06-0.29); p = 0.002), the left ventricular internal diameter in diastole (LVDd) (WMD (95 %CI) 0.07 (0.02-0.12); p = 0.01), and the left ventricular mass index (LVMI) (WMD (95 %CI) 5.69 (2.69-8.69); p = 0.0002). In contrast, the left ventricular systolic function (WMD (95 %CI) -1.22 (-1.69 to -0.75); p < 0.00001) and diastolic function including E/A ratio and E/E' ratio (WMD (95 % CI) -0.13 (-0.24 to -0.01); p = 0.04; WMD (95 % CI) 1.71 (0.43 to 2.99); p = 0.009) were decreased in SLE patients. Patients with SLE are associated with significant alterations in cardiac structure and function as demonstrated by echocardiography. Data from this study suggest that echocardiographic assessment should be considered as a part of routine examinations for SLE patients clinically.
