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Cardiac involvement in a Spanish unicentric prospective cohort of patients with systemic lupus erythematosus
Jorge Álvarez Troncoso1, Clara Soto Abanades1, Ángel Robles Marhuenda1
1Servicio de Medicina Interna, Unidad de Enfermedades Autoinmunes Sistémicas, 16268Hospital Universitario La Paz, Madrid, Spain.
Insights
Cardiac involvement is common in Systemic Lupus Erythematosus (SLE). Early echocardiogram screening is vital for patients with SLE, especially those with symptoms or risk factors, to improve outcomes and reduce mortality.
Area of Science:
- Cardiology
- Rheumatology
- Internal Medicine
Background:
- Cardiac involvement is a frequent manifestation of Systemic Lupus Erythematosus (SLE).
- Transthoracic echocardiogram (TTE) aids in early detection of cardiac abnormalities in SLE.
- Limited studies explore TTE findings, risk factors, and long-term outcomes in SLE cardiac involvement.
Purpose of the Study:
- Investigate the prevalence, risk factors, and outcomes of cardiac involvement in SLE.
- Analyze Transthoracic Echocardiogram (TTE) findings and their association with clinical and laboratory markers.
- Determine the impact of cardiac involvement on disease progression and mortality in SLE patients.
Main Methods:
- Prospective, single-center study of 201 SLE patients meeting 2019 EULAR/ACR criteria.
- All patients underwent Transthoracic Echocardiogram (TTE).
- Analysis of clinical data, laboratory markers (Troponin I, NTproBNP), autoantibodies, and follow-up outcomes.
Main Results:
- Cardiac involvement detected in 43.8% of SLE patients.
- Risk factors included older age, hypertension, hyperlipidemia, obesity, and cardiovascular events.
- Neurological, hematological, and serosal involvement were clinical risk factors for abnormal TTE.
- Specific symptoms (dyspnea, chest pain, cough, syncope) and biomarkers (Troponin I, NTproBNP) correlated with cardiac abnormalities.
- Anti-B2GP1 autoantibody was associated with cardiac involvement.
- Cardiac involvement correlated with higher SLICC Damage Index and increased 2-year mortality risk.
Conclusions:
- Cardiac involvement in SLE is diverse, heterogeneous, and highly prevalent.
- Pathological TTE findings are linked to increased disease damage and mortality.
- Echocardiographic screening is essential for early diagnosis and management of cardiac involvement in SLE, particularly in symptomatic patients or those with risk factors.
Background:
Cardiac involvement is one of the most frequent manifestations of Systemic Lupus Erythematosus (SLE). Transthoracic echocardiogram (TTE) may be valuable for the early detection of cardiac abnormalities in SLE. Few studies analyze both TTE findings in SLE and the risk factors that predispose to different cardiac manifestations in a long follow-up cohort. We aimed to investigate cardiac involvement's prevalence, risk factors, and outcomes in a Spanish Lupus Clinic.
Methods:
Spanish single-center prospective study of cardiac involvement in SLE. Two hundred and one patients met the 2019 EULAR/ACR classification criteria, performed TTE, and were eligible for the study.
Results:
Cardiac involvement was present in 43.8%. Patients with older age, hypertension, hyperlipidemia, higher body mass index, peripheral arterial disease, thrombosis, and major cardiovascular events had significantly more cardiac involvement. Neurological, hematological, and serosal involvement (pleuritis and/or pericarditis) were clinical risk factors for abnormal TTE. The combination of the four clinical variables (dyspnea, chest pain, cough, and/or syncope) was present in 40.9% of the patients with abnormal TTE in the follow-up and was superior to each of the manifestations separately. Troponin I (TnI) ≥ 0.2 ng/mL and NTproBNP ≥ 300 pg/mL were excellent biomarkers with a good correlation with cardiac abnormalities. Anti-B2GP1 was the only autoantibody associated with cardiac involvement in our cohort. Presenting cardiac involvement was correlated with higher SLICC Damage Index and increased mortality risk in the 2-year follow-up period.
Conclusions:
Cardiac involvement in SLE is diverse, heterogeneous, and highly prevalent. Presenting a pathological TTE was associated with greater damage accrual and greater mortality. Based on our results, we consider that echocardiographic screening of patients with SLE is essential, especially those symptomatic and/or with risk factors, to diagnose and treat cardiac involvement earlier.
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