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A Methodological Approach to Non-invasive Assessments of Vascular Function and Morphology
Published on: February 7, 2015
Detection of Vascular Changes in Systemic Lupus Erythematosus by Carotid Duplex Study in A Tertiary Cardiac Hospital
N Fatema1, C M Ahmed, S A Ahsan
1Dr Nilufar Fatema, Consultant, Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh;
Insights
Systemic lupus erythematosus (SLE) patients show increased carotid artery wall thickness and blood flow velocity compared to healthy individuals. Carotid duplex studies can detect these early vascular changes in asymptomatic SLE patients, aiding stroke prevention.
Area of Science:
- Cardiology
- Rheumatology
- Vascular Medicine
Background:
- Systemic lupus erythematosus (SLE) is a prevalent autoimmune connective tissue disorder predominantly affecting females.
- Cardiovascular complications are a significant cause of morbidity and mortality in SLE patients.
- Early detection of vascular changes in SLE is crucial for timely intervention and stroke prevention.
Purpose of the Study:
- To evaluate subclinical vascular changes in the carotid arteries of SLE patients without cardiovascular symptoms.
- To compare carotid artery structure and blood flow parameters between SLE patients and age-matched healthy controls.
Main Methods:
- A cross-sectional study involving 50 SLE patients (diagnosed by ACR criteria) and 50 healthy controls.
- Exclusion criteria included pre-existing cardiovascular diseases, other inflammatory conditions, and hypothyroidism.
- Carotid duplex study was performed to assess Intima-Media Thickness (IMT), Peak Systolic Velocity (PSV), and End Diastolic Velocity (EDV) in carotid arteries.
Main Results:
- SLE patients exhibited significantly increased IMT in both right (0.86±0.10 mm) and left (0.89±0.14 mm) common carotid arteries compared to controls (0.73±0.06 mm and 0.76±0.10 mm, respectively; p=0.001).
- Carotid artery blood flow velocities (PSV and EDV) were significantly higher in SLE patients on both sides (p=0.001).
- Vascular changes, including increased IMT and altered blood flow, were evident in the majority of SLE patients, even in the absence of clinical symptoms.
Conclusions:
- Subclinical carotid artery structural and hemodynamic changes are common in SLE patients, irrespective of cardiovascular symptoms.
- Carotid duplex study is a valuable non-invasive tool for early detection of vascular abnormalities in SLE.
- Identifying these early changes can help in implementing strategies to prevent future cardiovascular events like stroke in SLE patients.
Abstract:
Systemic lupus erythematosus (SLE) is a common autoimmune connective tissue disorder and mainly affected female patients. This cross sectional study was performed in the department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2008 to June 2012. A total fifty (50) SLE patients were diagnosed on the basis of ACR criteria, having no cardiovascular symptoms. Another 50 age-matched normal individuals were included to compare with SLE group. Congenital vascular disease, ischaemic heart disease, congenital heart disease, rheumatic heart disease, hypothyroidism and any other inflammatory disease along with SLE were excluded from study. All patients were evaluated by Carotid duplex study. Mean age of SLE was 26.70±7.3 and mean age of normal subject was 25.64±8.01. Most of the SLE patients were female (about 92%) and male (about 8%). And about 94% was female in normal group and 6% was male. In Right common carotid arteries (RCCA), mean Intema medial thickness (IMT) was 0.86±0.10 IN SLE group and 0.73±0.06 in normal group. In LCCA, mean IMT was 0.89±0.14 in SLE group and 0.76±0.10 in normal group. IMT in SLE group was increased than control group. There was a significant difference (p=0.001) in both right and left side. The percentage rate of change in PSV and EDV of Carotid arteries of the SLE group was significantly higher than the control group (Both left and right side p=0.001). In RCCA, the PSV was 91.72±19.46 in SLE group and 62.60±6.66 in normal group (p=0.001). And EDV was 27.02±8.23 in SLE group and 16.48±2.32 in normal group (p=0.001). In LCCA, the PSV was 82.06±22.28 in SLE group and 60.36±7.54 in normal group (p=0.001). And EDV was 27.82±6.61 in SLE group and 18.08±2.69 in normal group (p=0.001). In LICA, mean PSV was 83.46±23.54 in SLE group and 60.36±7.54 in normal group (p=0.001). And EDV was 29.36±8.56 in SLE group and 18.08±2.69 in normal group (p=0.001). In RICA, mean PSV was 61.56±7.66 in SLE group and 62.16±5.35 in normal group (p=0.651) which was not significant. And EDV was 26.36±2.26 in SLE group and 19.00±2.17 in normal group (p=0.001). But majority of the vessels showed significant P value which signifies that vascular changes were more evident in SLE group than normal control group. SLE patients with carotid artery blood flow velocity and structural changes in endothelial function changes more evident than control group. Compared with the normal control group, IMT, PSV and EDV were significantly higher in SLE group, the difference was statistically significant (P<0.05). Vascular changes are common in SLE when clinically asymptomatic. Carotid duplex study is a non invasive tool for early detection of vascular changes to prevent stroke in SLE patients.
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