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Accumulation of Microvascular Target Organ Damage in Systemic Lupus Erythematosus Patients Is Associated with

Nikolaos Koletsos¹, Antonios Lazaridis¹, Areti Triantafyllou¹

¹3rd Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece.

Journal of Clinical Medicine

|April 13, 2024

Insights

Systemic lupus erythematosus (SLE) patients show increased target organ damage (TOD) and cardiovascular (CV) risk due to microvascular dysfunction. Early detection of these microvascular alterations is crucial for managing SLE patients.

Area of Science:

Cardiovascular disease research
Autoimmune disease pathophysiology
Microvascular function assessment

Background:

Systemic lupus erythematosus (SLE) is linked to significant cardiovascular (CV) burden, including arterial stiffness and atherosclerosis.
Microvascular dysfunction is a key, yet understudied, factor in SLE-related CV disease.
The impact of cumulative target organ damage (TOD) on CV health in SLE requires further investigation.

Purpose of the Study:

To identify microvascular changes across various vascular beds in SLE patients.
To examine the association between accumulated microvascular TOD and overall CV risk.
To determine if Galectin-3 predicts combined microvascular TOD in SLE.

Main Methods:

Assessed skin microvascular reactivity using laser speckle contrast analysis.
Evaluated retinal microvasculature via non-mydriatic fundus camera.
Measured myocardial perfusion indirectly using subendocardial viability ratio and urine albumin-to-creatinine ratio (UACR).
Calculated CV risk with QRISK3 and measured serum Galectin-3 levels.

Main Results:

SLE patients exhibited impaired skin microvascular reactivity, retinal arteriolar narrowing, and higher UACR compared to controls.
SLE patients had elevated Galectin-3 levels, higher QRISK3 scores, and increased prevalence of microvascular dysfunction.
Accumulation of TOD in SLE correlated significantly with disease activity and Galectin-3 levels.

Conclusions:

SLE patients demonstrate a higher incidence of TOD, particularly microvascular alterations.
The cumulative burden of TOD is significantly associated with increased cardiovascular risk in SLE.
Clinicians should proactively screen for microvascular changes in SLE patients to mitigate CV risk.

Read full analysis

Abstract:

Background: Systemic lupus erythematosus (SLE) is a prototype autoimmune disease associated with increased cardiovascular (CV) burden. Besides increased arterial stiffness and subclinical atherosclerosis, microvascular dysfunction is considered an important component in the pathophysiology of CV disease. However, there is a lack of data regarding the effect of multiple target organ damage (TOD) on CV health. Objectives: This study aimed to evaluate (i) the presence of microvascular changes in SLE in various vascular beds, (ii) the possible associations between the accumulation of microvascular TOD and CV risk and (iii) whether Galectin-3 represents a predictor of combined microvascular TOD. Methods: Participants underwent (i) evaluation of skin microvascular perfusion (laser speckle contrast analysis), (ii) fundoscopy (non-mydriatic fundus camera), (iii) indirect assessment of myocardial perfusion (subendocardial viability ratio) and (iv) determination of urine albumin-to-creatinine ratio (UACR). CV risk was calculated using the QResearch Risk Estimator version 3 (QRISK3). Serum Galectin-3 levels were determined. Results: Forty-seven SLE patients and fifty controls were studied. SLE patients demonstrated impaired skin microvascular reactivity (160.2 ± 41.0 vs. 203.6 ± 40.1%), retinal arteriolar narrowing (88.1 ± 11.1 vs. 94.6 ± 13.5 μm) and higher UACR levels compared to controls. Furthermore, SLE individuals had significantly higher Galectin-3 levels [21.5(6.1) vs. 6.6(6.6) ng/dL], QRISK3 scores [7.0(8.6) vs. 1.3(3.6)%] and a greater chance for microvascular dysfunction. In the SLE group, patients with multiple TOD exhibited higher QRISK3. In the multivariate analysis, the accumulation of TOD correlated with disease activity and Galectin-3 (p < 0.05). Conclusions: Our study showed for the first time that SLE patients exhibit a greater number of cases of TOD. The accumulation of TOD was associated with increased CV risk. Clinicians dealing with SLE should be aware and seek microvascular alterations.

Keywords:

Galectin QRISK3 SEVR laser speckle lupus erythematosus microvascular dysfunction retina

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