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[Cardiovascular aspects of systemic lupus erythematosus pathology]
Insights
Systemic lupus erythematosus frequently affects the heart, particularly the myocardium. Immune system dysfunction and hypertension contribute to cardiac issues in lupus patients, impacting heart function and structure.
Area of Science:
- Cardiology
- Immunology
- Rheumatology
Context:
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse clinical manifestations.
- Cardiac involvement is a significant complication in SLE patients, affecting prognosis and quality of life.
Purpose:
- To investigate the prevalence and characteristics of cardiac affection in patients with SLE.
- To explore the role of cellular immunity and associated factors in the development of lupus-related heart disease.
Summary:
- A study of 213 SLE patients revealed cardiac involvement in 171 (80.3%), primarily affecting the myocardium (myocarditis, myocardial dystrophy).
- Cellular immunity disorders, assessed via leucocyte migration inhibition and myocardial antibodies, are implicated in lupus myocardial affection.
- Renal hypertension was associated with myocardial hypertrophy and altered cardiac hemodynamics.
- Steroid-induced cardiac issues and valvular abnormalities (mitral valve sclerosis, stenosis, aortic insufficiency) were also observed.
- Echocardiography proved valuable for early detection of cardiac hypertrophy and pericardial effusion.
Impact:
- Highlights the high incidence of cardiac complications in SLE, emphasizing the need for cardiac monitoring.
- Suggests a significant role for immune dysregulation in the pathogenesis of lupus cardiotoxicity.
- Underscores the utility of echocardiography in the early diagnosis and management of cardiac manifestations in SLE.
Abstract:
The authors had 213 patients under observation with systemic lupus erythematosus. Changes in the heart were revealed in 171 patients, all had affection of the myocardium: myocarditis was found in 66 and myocardial dystrophy in 122. Appraisal of leucocyte migration inhibition with the myocardial antigen (in 23 patients) and detection of antibodies against the myocardium by immunofluorescence (in 33) suggest that disorders in cellular immunity play an important part in the development of lupus myocardial affection. Involvement of the heart in patients with systemic lupus erythematosus was partly associated with renal hypertension, which was conducive, first and foremost, to the development of myocardial hypertrophy and could be attended with increased cardiac ejection and peripheral resistance. A decrease in the cardiac output with a gradual growth in the activity of systemic lupus erythematosus was noted. Steroid myocardial affection was found in 1/4 of patients, which sometimes occurred with cardiac insufficiency and signs of inflammation. Besides mitral valve sclerosis (7%), mitral stenosis was revealed in 3 patients and aortic insufficiency in one. Echocardiography helped to make an early diagnosis of hypertrophy of the heart and pericardial effusion in patients with systemic lupus erythematosus.